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BENIGN (PEPTIC) STRICTURE. Group D Mamba - Medenilla. BENIGN (PEPTIC) STRICTURE. Peptic Stricture Results from fibrosis that causes luminal constriction. Source : p.1851. BENIGN (PEPTIC) STRICTURE. Clinical features. Diagnosis. General principles of Treatment. Clinical features.

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benign peptic stricture

BENIGN (PEPTIC) STRICTURE

Group D

Mamba - Medenilla

benign peptic stricture1
BENIGN (PEPTIC) STRICTURE
  • Peptic Stricture
    • Results from fibrosis that causes luminal constriction

Source:

p.1851

benign peptic stricture2
BENIGN (PEPTIC) STRICTURE

Clinical features

Diagnosis

General principles of Treatment

slide4

Clinical features

Source:

p.1851

benign peptic stricture clinical features
BENIGN (PEPTIC) STRICTUREClinical features

Patient

Benign Peptic Stricture

  • History
    • Difficulty of swallowing
    • Regurgitation of sour material
    • Chest pain after eating
    • Copious sputum upon waking up
    • Dysphagia to solid foods
    • Occasional vomiting of previously taken in food
    • Symptoms relieved by Omeprazole but would recur intermittently
    • Weight loss of 8 kg
  • History
    • Progressive dysphagia to solid food
    • Heartburn and chest pain
    • Odynophagia
    • Food impaction
    • Weight loss

Esophageal stricture, http://emedicine.medscape.com/

benign peptic stricture clinical features1
BENIGN (PEPTIC) STRICTUREClinical features

Patient

Benign Peptic Stricture

  • Physical exam
    • BMI: 17.63 kg/m^2
    • Vital signs normal
    • Pulmonary: No crackles nor wheezes
    • Cardiac: Heart sounds unremarkable
    • Abdominal: scaphoid abdomen, non tender, no masses
    • Neurologic: no evident deficit
  • Physical exam
    • Physical examination frequently does not provide clues to the cause of dysphagia.
    • Assess nutritional status

Esophageal stricture, http://emedicine.medscape.com/

benign peptic stricture3
BENIGN (PEPTIC) STRICTURE

Clinical features

Diagnosis

General principles of Treatment

benign peptic stricture4
BENIGN (PEPTIC) STRICTURE

Clinical features

Diagnosis

General principles of Treatment

slide11

For patients [with GERD] + associated peptic stricture

General principles of Treatment

Source:

p.1852

pretreatment classification
Pretreatment Classification
  • Consider severity of the condition and complications following treatment
  • preoperative evaluation, preoperative and pretreatment assessment of the patient, as well as the character of the stricture.
medical care
Medical Care
  • more emphasis has been placed on mechanical dilatation
  • coexistent esophagitis has been relatively ignored
  • several studies have demonstrated that aggressive acid suppression using PPIs is extremely beneficial in the initial treatment, as well as long-term management.
medical care1
Medical Care
  • Studies have shown that aggressive acid-suppression therapy with PPIs both improve esophagitis and decrease the need for subsequent esophageal dilatation
  • PPI therapy has to be individualized, depending on the level of reduction in acid exposure as assessed by 24-hour pH monitoring.
ppi s
PPI’s

Omeprazole (Prilosec)

Decreases gastric acid secretion by inhibiting the parietal cell H+/K+ -ATP pump.

Adult : 20 mg PO qam 30 min ac; may increase bid

Lansoprazole (Prevacid)

Suppresses gastric acid secretion by specifically inhibiting H+/K+- ATPase enzyme system at the secretory surface of gastric parietal cells.

Adult : 30 mg PO qam 30 min ac; may increase to 30 mg bid

Rabeprazole (Aciphex)

Decreases gastric acid secretion by inhibiting the parietal cell H+/K+ ATP pump.

Adult :20 mg PO qam 30 min ac; may increase to 20 mg PO bid if necessary

ppi s1
PPI’s

Pantoprazole (Protonix)

Decreases gastric acid secretion by inhibiting the parietal cell H+/K+ ATP pump.

Adult : 40 mg PO qam 30 min ac; may increase to bid

Esomeprazole magnesium (Nexium)

S-isomer of omeprazole. Inhibits gastric acid secretion by inhibiting H+/K+ -ATPase enzyme system at secretory surface of gastric parietal cells.

Adult : 20-40 mg PO qd for 4-8 wk

surgical care endoscopic and surgical modalities
Surgical Care (endoscopic and surgical modalities )
  • choice of dilator and technique is dependent on many factors, the most important being stricture characteristics
  • factors, including patient tolerance, operator preference, and experience.
  • dilatation therapy should be tailored individually
endoscopic therapy
Endoscopic Therapy
  • Three types:
    • mercury field bougies
    • polyvinyl bougies
    • balloon dilators
    • Usually the physician passes a series of dilators or gradually increases the diameter of the balloon to stretch out the stricture.
    • complications such as perforation and bleeding occurred in approximately 0.5% of all esophageal dilation procedures
surgical therapy
Surgical Therapy
  • Conservative antireflux surgery with classic fundoplication has been employed for peptic stricture patients with a long-term success rate ranging from 65 to 90%.
  • laparoscopic approach report a 12% failure rate, whereas others demonstrate significantly higher recurrence rates (25%).
  • esophageal lengthening gastroplasty of the Collies-Nissen type or Collies-Belsey Mark IV type have been proposed
slide21

Surgical Therapy

  • More mutilating surgical procedures, incorporating partial gastrectomy, vagotomy with or without biliary diversion, or duodenal switch procedures have been introduced.
  • Esophageal resection has been proposed in patients with severe stricture, poor contractility, or high-grade dysplasia.
benign peptic stricture non pharmacologic treatment
BENIGN (PEPTIC) STRICTURENon-pharmacologic treatment

Diet

  • Avoid fatty and spicy foods, alcohol, tobacco, chocolate, and peppermint.
  • Not to eat at least 2-3 hours before bedtime.
  •  Should eat smaller meals, avoid eating in a hurried fashion, and chew their food well.
  •  Weight reduction
  •  Ill-fitting dentures or poor dentition should be corrected if possible.