UPDATES on Acid-Related Digestive Disorders. Disorders that are characterized by an imbalance between mucosal defense mechanisms And gastric acid secretion. DEFINITION OF ACID RELATED DISORDERS. Peptic ulcer disease gastroesophageal reflux disease.
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These figures will definitely make a big burden on health resources on most countries
Both disorders could present in a variable ways that force us to remember these diseases, specially in risk group populations
These costs has limited the planning of an effective treatments and preventive programs which need very high budgets which is beyond facilities of many countries
Chief symptoms include heartburn, food regurgitation into the throat, occasional difficult or painful swallowing, and occasional chest pain.
symptoms include cough, and wheezing,or vocal cord inflammation leading to hoarseness of voice, and other ENT symptoms.
* atypical symptoms are predominant in up to
27% of GERD patients.
* in onestudy, the frequency of symptoms :
more accurate tests are needed
to confirm atypical reflux
therefore, ambulatory pH monitoring, has
been unable to confirm all cases of atypical GERD
(the possibility of recording abnormal acid exposure is 70-80% by the distal esophageal probe , but only 50-55% in the proximal probe).
for patients with persistent symptoms
despite full acid suppression therapy
MII-pH shows a promise
to become an important clinical tool
particularly to assess atypical GERD
BMC Gastroenterol. 2005; 5: 2
impact of hiatal hernia on histological pattern of non-erosive reflux disease, Anthie Gatopoulou, etal,
1. In erosive disease :
HH was usually correlated with more
severe endoscopic erosions.
2. In non erosive disease :
HH is also correlated with severe biopsy
when GERD symptoms doesn’t respond
to usual therapeutic measures, and associated with large Hiatus Hernia, surgery will be then advisable
or drink a lot of carbonated beverages
or experience daytime sleepiness
or have insomnia
or use anti-anxiety medications
CONCLUSIONS FROM STUDY
79% of patients with early (GERD)
suffer from reflux symptoms
that awakens them during night
Without clear symptoms of heatburn
People with nighttime heartburn
are at greater risk of developing
serious esophageal complications
And have a frequent
heartburns in past year
reported sleep problems
at least twice a month
INDICATIONS OF SUREGERY IN GERD
1.persistence of erosive esophagitis, one year after adequate medical
therapy is the most accepted indication for surgery.
2. But, severe symptoms, even after improvement of erosions, and in spite
of adequate medical treatment is a relative indication.
Associated Complications is a strong indication for surgery
Failure of medical therapy is a relative indication for surgery
may cause ulcers only in rare cases
beginning in 1958 John Lykoudis, a general practitioner in Greece, was treating his patients for peptic ulcer disease with antibiotics, long before H pylori and it’s relation to ulcers was recognized.
Helicobacter pylori was then discovered in
1982 by two Australian scientists, J. Robin
Warren and Barry J. Marshall as a
causative factor for peptic ulcers.
H. pylori discovery was poorly accepted in the beginning, so in an act of removing doubts by self-experimentation, Marshall Barry drank a Petri dish containing a culture of H P organisms extracted from infected patient, and he soon developed severe H P gastritis. His symptoms disappeared then after two weeks, following being forced to take antibiotics to kill the ingested bacteria at the urge of his wife, since he got severe halitosis, which is one of the symptoms of H Pylori gastric infection.
experiment was published in 1984 in the Australian Medical Journal
In 2005, the Karolinska Institute in Stockholm awarded the Nobel Prize in Physiology of Medicine to Dr. Marshall Barry and his long-time collaborator Dr. Warren "for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease".
1. Old People over 65.
2. People with history of ulcers or upper GI bleeding.
3. Those with heart disease.
4. Users of certain medications, such as the anticoagulants,
corticosteroids, or alendronate.
5. Alcohol users.
6. H. pylori infected people.
Given the widespread use of these factors, however, the total number of people with confirmed disease is considerable
investigators from Hong Kong randomized 100 arthritic patients with confirmed H. pylori infection to receive either one week of :
1. standard triple eradication therapy
2. omeprazole alonewithout antibiotics.
One week triple therapy
One week omeprazol only
All given 100 mgs Dicofenac for 6 months
In 10% of antibiotic and PPI recipients
In 30% of omepazol only recipients
The investigators concluded that treatment for H. pylori infection before initiating NSAID therapy will reduce the risk for developing peptic ulcers.
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