benign peptic stricture or gastro-esophageal reflux disease (gerd )
DESCRIPTION
Group D Florendo-Gaspar. Benign Peptic Stricture or Gastro-Esophageal Reflux Disease (GERD ). GERD. Symptoms manifests when gastric acid and other gastric contents backflow into the esophagus →burning sensation “heartburn” Almost everyone has occasional heartburn usually after meals. - PowerPoint PPT PresentationTRANSCRIPT
Symptoms manifests when gastric acid and other gastric contents backflow into the esophagus →burning sensation “heartburn”
Almost everyone has occasional heartburn usually after meals.
If symptoms occur ≥2 a week for at least 3months, it may be a GERD. http://www.gerd.com
Harrison’s Principles of Internal Medicine, 17th edition
One of the most prevalent GI disorders. 15% of individuals have heartburn and/or
regurgitation at least once a week 7% - 10% of the population experience
symptoms of heartburn daily. Most cases of heartburn occur because of
excess acid reflux 10% of patients with functional heartburn Many individuals control symptoms with OTC
medications without consulting a medical professional, thus, is likely underreported.
http://www.gerd.com Harrison’s Principles of Internal Medicine, 17th edition
Occurs in all age groups Prevalence increases in people older than
40 y/o No sexual predilection exists (M=F) White males are at a greater risk for
Barrett esophagus and adenocarcinoma than other populations. 8-15% of patients with GERD → adenocarcinoma
50% of patients develop esophagitis GERD is a chronic, but treatable condition,
and it is extremely common. http://www.gerd.com Harrison’s Principles of Internal Medicine, 17th edition
The LES plays an important role in digestion.
It may open more often than it should or it may open at the wrong times, allowing stomach acid to back up into the esophagus.
This can be extremely painful.
If this continues for a long time, a portion of the esophagus can become “raw.” This is called erosive esophagitis and it can lead to serious medical problems (scarring, bleeding and ulcers)
http://www.gerd.com
Reflux happens when gradient b/w LES and stomach is lost and is usually due to transient or sustained decrease in LES tone.
Transient hypotension of LES is due to: Vagovagal reflex
Harrison’s Principles of Internal Medicine, 17th edition
Sustained hypotension of LES may be due to: Muscle weakness Scleroderma-like diseases Myopathy associated with chronic intestinal
pseudoobstruction Pregnancy Smoking Anticholinergic drugs Smooth-muscle relaxants Surgical damage to the LES, and esophagitis
Harrison’s Principles of Internal Medicine, 17th edition
(1)Increase in gastric volume• After meals with pyloric obstruction,
gastric stasis, acid hypersecretion state(2)Close proximity of gastric
contents to the GEJ• Recumbency, bending down, hiatal
hernia(3)Increase in gastric pressure • Obesity, pregnancy, ascites, tight clothes
Harrison’s Principles of Internal Medicine, 17th edition
1. Reflux esophagitis2. Mild esophagitis3. Erosive esophagitis4. Peptic stricture
Harrison’s Principles of Internal Medicine, 17th edition
• Develops when the damage caused by acid, pepsin, and bile cannot be counteracted by the mucosal defenses
Harrison’s Principles of Internal Medicine, 17th edition
Micsoscopic changes▪ Mucosal infiltration with granulocytes, or
small numbers of eosinophils▪ Hyperplasia of basal cells▪ Elongation of dermal pegs
Harrison’s Principles of Internal Medicine, 17th edition
Mucosal damage with redness, friability, superficial linear ulcers, exudates
• Histology▪ Polymorphonuclear infiltrates▪ Mild eosinophilic infiltrates▪ Granulation tissue .
• May heal by intestinal metaplasia →Barrett’s esophagus
Harrison’s Principles of Internal Medicine, 17th edition
Luminal constriction resulting from fibrosis
2 types:1. Short strictures▪ 1-3 cm ▪ seen in the distal esophagus, near the GEJ
caused by spontaneous reflux
2. Long/Tubular strictures▪ Caused by persistent vomiting or by
prolonged NGT intubationHarrison’s Principles of Internal Medicine, 17th edition
Induced by the contact of refluxed material with the sensitized or ulcerated esophageal mucosa
Angina like/ atypical chest pain