Transcript GIT diseases


Aphthous:
• Idiopathic
• Pre-menstrual

Infection:
• Fungal e.g. Candidiasis
• Bacterial e.g. Vincent’s angina, Syphilis
• Viral e.g. herpes simplex

GIT diseases:
• Crohn’s disease
• Celiac disease

Dermatological conditions:
• Lichen planus dermatitis herpetiformis
• Pemphigus erythema multiformi
• Pemphegoid

Drugs:
• Hypersensitivity e.g. Steven’s Johnson
syndrome NSAID losartan ACE inhibitor
cytotoxic

Systemic diseases:
• SLE
• Behcet’s disease

Neoplasia:
• Carcinoma
• Leukemia
• Kaposi’s Sarcoma
Oral ulceration in patient
with aplastic anemia
Aphthous ulceration
Deep ulcers in
patient with
Behcet Disease
Oral thrush
Chronic oral
candidiasis
Acute oral
candidiasis
Herpes Simplex
Angular Stomatitis &
atrophic glossitis in
patient with IDA
Angular Stomatitis
Stevens Johnson’s
syndrome
Lichen planus
Peutz Jegher syndrome
Scurvy
Gingival hypertrophy due
to phenytoin therapy
Lead poisoning
Yellow staining of teeth due to
Tetracyclin therapy

Gastro-Esophageal Reflux
Disease (GERD):
• It is a chronic disorder which
describes
any
symptomatic
or
histopathologic alteration resulting
from episodes of gastro-duodenal
reflux into the esophagus and/or
adjacent
organs
more
than
twice/week for more than 2 months

ERD
•Erosive
Reflux
Disease
1/3

NERD
•Non
Erosive
Reflux
Disease
2/3

Typical:

Heartburn

Acid regurgitation

> 2x/week

> 4 to 8 weeks

Esophageal:
 Pulmonary:
1. Non-cardiac
1. Asthma
chest pain
2. Non-obstructive
dysphagia
3. Globus
hystericus
2. Chronic cough
3. Hemoptysis
4. Bronchitis
5. Bronchiectasis
6. Recurrent
pneumonia

Otorhinolaryn
gological:
1. Hoarseness
2. Throat
cleaving
laryngitis
3. Sinusitis
4. Otolagia

Oral
1. Etching of
dental enamel
2. Halitosis
B
G
E
D
ily
)
R
(d
a
G
E
y
k
>1
x/
da
D
B
>1
x/
w
ee
R
H
)
th
(to
ta
l
>1
x/
m
on
B
B
H
H
H
40%
35%
30%
25%
20%
15%
10%
5%
0%
Shubbar & Taka

Increasing Prevalence:
•1976
•1988
15%
44%






Transient lower esophageal
sphincter (LES) relaxation
Hypotensive LES
Delayed Esophageal clearance
Delayed gastric emptying
Salivary function
Tissue resistance


Age
Alarm features
• Dysphagia
• Odynophagia
• Weight loss
• GI bleeding
• Nausea &/or vomiting
• Family history of cancer

Nocturnal reflux

Indications:
1. Age over 40
years-old
2. Alarm features
3. Atypical
symptoms

Useful in:
1.
2.
3.
4.
Grading
Hiatus hernia
Ulcer or stenosis
Barrett’s
Esophagus
-ve endoscopy is seen in 2/3 of
GERD

Indications:
1. Atypical symptoms
2. NERD who do not respond to
PPI
3. When esophagitis is not
demonstrated in the preoperative endoscopic
examination . IMPEDANCE
testing
Symptoms
Antacids/Alginates
Proton pump inhibitor
Full dose
Good response
Proton pump inhibitor
Maintenance dose
H2 receptor
Antagonists
Antacids
Poor response
Reconsider
diagnosis
Consider pH
Monitoring
Normal
Fundoplication
Behavioral modifications in the
treatment of GERD
1. Elevation of the headboard of
the bed (15 cm)
2. Ingestion of the following foods
in moderation & based on
symptom correlation: fatty
foods, citrus, coffee, chocolate,
alcoholic & carbonated
beverages, mint, tomato-based
products.
Behavioral modifications in the
treatment of GERD
3. Special care with at risk medications:
anticholinergics, theophylline, tricyclic
antidepressants, Ca channel blockers,
B-Adrenergic agonists, alendronate.
4. Avoidance of lying down for
after meals
2 hrs
5. Avoidance of large meals
6. Drastic reduction in, or cessation of,
smoking.
7. Reduction of body weight if
overweight
Surgical treatment

Indications:
1. No response to medical
treatment including atypical
symptoms.
2. Continuous maintenance
treatment is required
especially in patients younger
than 40 year old.
3. Financial impediment
Complications
Barrett’s esophagus
 Stenosis
 Ulcer
 Bleeding
