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Curriculum VitaeNama
LahirAlamatIstriAnak/Mantu/CucuPendidikan
Pekerjaan
Pendidikan Tambahan
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:::::
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I Gede Arinton
Singaraja, 1 Januari 1950Jl. Pramuka 249 Purwokerto15/3/31. dr. umum FK. UNUD 19772. dr. SpPD FK. UNDIP 19873. MKom STIBBi Jkt 19994. MMR UNSUD 20055. KGEH FK. UI 20076. Doktor Ilmu Kedokteran UNDIP 2008Bag. Penyakit. Dalam RSUD. Margono
Soekarjo/FKIK Unsud Purwokerto1. Pelatihan Endoscopy di RSU dr.
Hasan Sadikin Bandung.2. International Endoscopy Workshop
2007, Jakarta 5 7 April 2007.3. Training Endoscopy Showa
University Yokohama 2009
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Dx. & Management
Dyspepsia-GERDDr.dr. I Gede Arinton,SpPD-KGEH
The Internal Medicine of FKIK Unoed
Purwokerto
2014
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IntroductionDyspepsia
not a disease but a symptom complex
The prevalence: 25% general pop.
not a life-threatening disease
not associated with an increased
mortality rate
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IntroductionDyspepsia
But impact on patients and health care
services -> seek medical help: quality of life -> reduced
20% -> fear from possible malignancy
Economic loss : > 50% ->medicamentous th/
30% absence from work or school
30-60% objective examinations : biochemical
testing, endoscopic or radiologic studies
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IntroductionGERD :
the prevalence of at least monthly
GERD symptoms : 26-44%.
up to 20%, with an incidence rate
C/ 15 20% -> 0.5% AdenoCa
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Locke et al. Gastroenterology1997;112:1148.
High Prevalence ofGastroesophageal Reflux
Symptoms
19.8%
59%
0%10%20%30%40%
50%60%
Weekly MonthlyFrequency of heartburn and/or
regurgitation
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DiagnosisDyspepsia
Greek Dys = bad + Pepse =
digestion : bad digestion
Indigestion
Rome II :
pain or discomfort centered in the upper
abdomen.
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DiagnosisDyspepsia
UnInvestigated
Investigeted - Endos, BaEnema :
Organic
Functional - 60% Primary Practice.
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Rome III :FUNCTIONAL DYSPEPSIA
Dx. criteria* - One or more : Bothersome postprandial fullness
Early satiation Epigastric pain Epigastric burning
AND
Endos- structural
the last 3 months+ at least 6 months prior
to diagnosis
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Diagnosis
GERD : heart burn or stomach
material refluxing from the stomach
into the esophagus
Organic : ERD & Functional : NERD.
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Rome III :Functional Esophageal
Disorders A1. Functional Heartburn
A2. Functional Chest Pain of Presumed
Esophageal Origin
A3. Functional Dysphagia
A4. Globus
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Acid Related Diseases
Dyspepsia
GERD
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PathoPhysiology
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Parietal cells
Wolfe, 2006
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GASTRIC ACID
SECRETION Cephalic phase
Gastric phase
Intestinal phase
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ExtraesophagealManifestations of GERD
Pulmonary AsthmaAspiration
pneumoniaChronic bronchitisPulmonary fibrosis
Other Chest painDental erosion
T HoarsenessLaryngitisPharyngitisChronic coughGlobus sensationDysphoniaSinusitisSubglottic
stenosisLaryngeal cancer
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Potential Oral and LaryngopharyngealSigns Associated with GERD
Edema and hyperemia of
larynx
Vocal cord erythema,
polyps, granulomas,
ulcers
Hyperemia and lymphoid
hyperplasia of posterior
pharynx
Interarytenyoid changes
Dental erosion
Subglottic stenosis
Laryngeal cancerVaezi MF, Hicks DM, Abelson TI, Richter JE. Clin Gastro Hep 2003;1:333-
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Pathophysiology ofExtraesophageal GERD
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Symptoms ofComplicated GERD
Dysphagia
Difficulty swallowing: food sticks or
hangs up
Odynophagia
Retrosternal pain with swallowing
Bleeding
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Diagnostic Tests for
GERD Barium swallow Endoscopy
Ambulatory pH
monitoring
Esophageal
manometry
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Endoscopy Indications for
endoscopy
Alarm symptoms
Empiric therapy failure
Preoperative evaluation
Detection of Barretts
esophagus
A b l t 24 h H
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Ambulatory 24 hr. pHMonitoring
Physiologic study
Quantify reflux in
proximal/distal
esophagus % time pH < 4
DeMeester score
Symptom
correlation
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Ambulatory 24 hr. pH Monitoring
Normal
GERD
Wireless Catheter Free Esophageal pH
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Wireless, Catheter-Free Esophageal pHMonitoring
Improved patientcomfort andacceptance
Continued normal
work, activities anddiet study
Longer reportingperiods possible (48
hours) Maintain constantprobe position relativeto SCJ
Potential Advantages
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Esophageal Manometry
Assess LES pressure,
location andrelaxation
Assist placement of 24
hr. pH catheter
Assess peristalsis
Prior to antireflux
surgery
Limited role inGERD
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Management :
ICSI algorithm
Refer
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Devlin et al,2005
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Summary HCl secreted by the stomach is
believed to play a crucial pathogenic
role. The diagnostic algorithm in
dyspepsia must be adjusted
according to the a priori probability
of relevant diagnosis
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Summary
A fundamental abnormality in GERD
is excessive reflux of gastric
contents across the EGJ.
Dx. GERD - clinical history-
challenge for even the most skilled
clinician.
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