1. "Each time you are honest
and conduct yourself with
honesty, a success force will
drive you toward greater
success. Each time you lie,
even with a little white lie,
there are strong forces
pushing you toward failure."
Joseph Sugarman
Author and Marketing Specialist
Dr.Shashikant.S.K www.yogamaarg.com 1 01/24/13

2. GERD
Gastroesophageal reflux is a normal physiologic
phenomenon in most people, particularly after a
meal.
Gastroesophageal reflux disease (GERD) occurs
when the amount of gastric juice that refluxes into
the esophagus exceeds the normal limit
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3. Causes of GERD
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4. GERD: Symptoms
Typical symptoms:
 Heartburn (Pyrosis):
 Most common
 Felt as a retrosternal sensation of burning or discomfort
 Occurs usually after eating or when lying down or bending over.
 Often relieved with milk or water
 Regurgitation:
 Effortless return of gastric and/or esophageal contents into the
pharynx.
 It can induce respiratory complications if gastric contents spill
into the tracheobronchial tree.
Atypical symptoms
 Cough, dyspnea, hoarseness, and chestpain
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5. Diagnosis
Role out other potential causes for the heartburn:
 Cardiac
 Peptic ulcer
 Esophagitis
Esophageal Endoscopy:
 The gold standard as a definitive diagnosis
Barium swallow
 Not as definitive in mild cases
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6. Collaborative Care
Lifestyle modifications
Nutritional therapy
 Decrease high-fat foods, avoid milk products at night,
and avoid late snacking or meals
Drug Therapy
Surgical therapy
Endoscopic therapy
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7. Ulcer
7
Ulcers are defined as a breach in the mucosa
of the alimentary tract, which extends
through the muscularis mucosa into the
submucosa or deeper.
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8. APD
(Acid Peptic Diseases)
8
PEPTIC ULCER
AN ULCER OF THE ALIMENTARY TRACT
MUCOSA, USUALLY IN THE STOMACH OR DUODENUM,
& RARELY IN THE LOWER ESOPHAGUS, WHERE THE
MUCOSA IS EXPOSED TO THE ACID GASTRIC
SECRETION
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9. CAUSES OF A.P.D
9
1. STRONG FAMILY HISTORY
BLOOD GP ‘O’ ARE PRONE TO APD
11. TRIGGERING FACTORS
 STRESS - TENSION
“NOT ABLE TO LET GO THE STEAM”
 ALCOHOL, CHILLI,
 STEROIDS, PAIN KILLERS
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10. Pathogenesis of Ulcers
Therapy is directed at enhancing host defense or
5eliminating aggressive factors; i.e., H. pylori.
Aggressive Factors Defensive Factors
 Acid, pepsin  Mucus, bicarbonate layer
 Bile salts  Blood flow, cell renewal
 Drugs (NSAIDs)  Prostaglandins
 H. pylori  Phospholipid
 Free radical scavengers
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11. 11 Etiology of PUD
Normal
Increased Attack
Hyperacidity
Weak defense
Helicobacter pylori*
Stress, drugs, smoking
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12. 12
The Defensive Forces The Aggressive Forces
Bicarbonate Helicobacter pylori
When the layer
Mucus
aggressive factors increase or the
HCl acid
defensive blood flowdecrease, mucosal damage
Mucosal factors Pepsins
NSAIDs
will result, leading to erosions & ulcerations
Prostaglandins
Bile acids
Growth factors Ischemia and hypoxia.
Smoking and alcohol
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13. STRESS EMOTIONAL CORTEX
HYPOTHALAMUS
PARA SYMPATHETIC SYMPATHETIC
GASTRIN ACID BL. FLOW
POOR MUCUS
ACID SLOW REPAIR

14. 14
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15. Gastric Gland
15
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16. Three types of peptic ulcer
Gastric
Duodenal
Stress
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17. Gastric peptic ulcer:
17
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18. Medical Management of ulcers
 Conservative therapy:  Pharmaceutical:
 Rest: Both physical and  Antibiotics
emotional  To eradicate H. Pylori infections
 Recurrence of ulcer is 75-90% as high
 Dietary modifications with infection
 Elimination of smoking
 Antiacids
 Long term follow up  Initial drugs of choice
care  Histmaine H2 receptor antagonists
 Histamine is the final intracellular
activator of HCL secretion
 Anticholinergic:
 Stop the cholinergic stimulation of HCl
secretion and slow gastric motility
 Not commonly used, if used need to be
used with caution in pts with Glaucoma
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19. YOGIC MANAGEMENT
19
SATVIK FOOD
MODERATION IN EATING
SPECIAL TECHNIQUE FOR GID
COME OUT OF STRONG LIKES AND DISLIKES
COME OUT OF EXCESSIVE DESIRES
HAPPINESS ANALYSIS EG. GULAB JAMOON
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20. YOGIC MANAGEMENT
20
FOOD COOKED AND SERVED IN GOOD
ATMOSPHERE
SUBMISSION OF PRAYERS
GOOD POSTURES
GOOD YOGIC ACTIVITIES
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21. Irritable bowel syndrome (IBS)
Irritable bowel syndrome (IBS) is an intestinal
disorder that causes abdominal pain or discomfort,
cramping or bloating, and diarrhea or constipation.
Irritable bowel syndrome is a long-term but
manageable condition.
Sometimes called:
 “irritable colon”
 “spastic colon”

22. IRRITABLE BOWEL SYNDROME
PERSONALITY:
• HYPER - REACTIVE
• CLEAN
• NERVOUS
• INTROSPECTIVE
• FIXATION ON BOWEL
• CONCENTRATION ON THE BOWEL

23. CONTROL OF BOWEL MOTILITY
PSYCHE

24. BOWEL MOTILITY IN IBS
MUSCLE TONE DISORDER -
ERRATIC EMPTYING
OF BOWELS
HYPER REACTIVITY TO PARA SYMPATHO DRUGS
SYMPATHETIC
PARASYMPATHETIC

25. IBS Characteristics
25
There is usually no sign of structural damage to the
wall of the intestine (frequently indicated by blood
in the stool)
Weight loss or nighttime fever are not experienced
A diagnosis of irritable bowel syndrome is made
when all organic disease has been ruled out by
appropriate medical tests
The Manning Criteria or the Rome II
questionnaires are often used for diagnosis

26. Initial Triggers of IBS
26
Infection in the digestive tract:
 Viruses
 Bacteria
 Parasites (amoeba; intestinal worms)
Pathology in the digestive tract
 Inflammatory bowel disease
 Coeliac disease
Surgical procedures in the digestive tract

27. Triggers of IBS (continued)
27
Stress:
 Stress hormones are released
 Neuropeptides may trigger the release of inflammatory
chemicals
Hormone fluctuations:
 Menstrual cycle
 Pregnancy
 Thyroid

28. Triggers of 28 (continued)
IBS
Change in types of micro-organisms in the large
intestine due to:
 Oral antibiotics
 Other oral medications
 Change in substrate (ie type of food passing into the
bowel)
Alteration in microbial flora results in:
 Different products resulting from the action of micro-
organisms on undigested food material:
 Gases
 Organic acids
 Others

29. Mechanisms Responsible for Symptoms
29
Key factors in IBS resulting in symptoms
include:
 Inflammation
 Resulting from release of inflammatory mediators
 Increased sensitivity to pain
 Neuropeptides (tachykinins) generated by the central
nervous system interact with neurokinin receptors on the
spinal cord
 May also result from a response to inflammatory mediators
(e.g. histamine)

30. IBS
Collaborative Care
Diet modification
Fiber therapy (20 g/day)
Antispasmodics
Antidiarrheals
Laxatives
Serotonergic agents
Antidepressants

31. IBS
Nonpharmacologic Treatments
Education and reassurance
Relaxation
Stress management techniques
Alternative therapies –Yoga Therapy
Hypnotherapy

32. IAYT For GID
32
PANCHA PRANA
APANA
PRANA
SAMANA
UDANA
VYANA
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33. Panchakosha viveka
33
o Annamaya kosha
o Pranamaya kosha
o Manomaya kosha
o Vijnanamaya kosha
o Anandmaya Kosha
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34. Thank you
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