2. GASTROESOPHAGEAL REFLUX DISEASE
Defenition:
Prevalence:
Affects 20-50% of population in
European countries(20million people
daily experience heartburn)
10% of population everyday 20%
experience it weekly
Prevalence in Iran 21.2% Higher in
Asian countries
6. EXTRAESOPHAGEAL
MANIFESTATIONS
Chest pain
o Similar to Angina pectoris
o Located substernal
Asthma and pulmonary
disease
• In 30% of cases GERD is
associated by Asthma
• Cause chronic cough in 20%
• Aspiration
pneumonia,Interstitial
pulmonary fibrosis, Chronic
Bronchitis,Bronchiectasis,Cystic
fibrosis
10. Peptic
Stricture
Heartburn is relieved
Endoscopy and
biopsy
Treatment
I. Balloon dilatation
II. Polyvinyl catheter
III. Triamcinolone
11. DIFFERENTIAL DIAGNOSIS OF GERD
cardiovascular
Angina
pectoris
Esophagitis
Pill induced
espophagitis
Infectious
esophagitis
Radiation
esophagitis
Gastric
Peptic
ulcer
Achalasia,DES
Esophagea
l motility
disorder
functional
Non ulcer
dyspepsia
12. TREATMENT
Mild intermittent symptoms
Lifestyle modification
o Sleeping 3h after dinner
o Head elevation 6 inches
o Avoid foods high in
fat,tomato,spicy foods,alcohol
,cigarettes coffee
Antiacids
H2 receptor blockers
Troublesome symptoms
PPI +Sodium bicarbonate OD for
4-8 weeks-8-12 weeks
In barrett’s esophagitis,severe
esophagitis,peptic stricture PPI BID
Unresponsive patients:High dose
PPI
o Omeprazole 40mg BID
o Seek for ZES,pill induced
esophagitis in refractory cases
15. Viralesophagitis
Symtpoms:dysphagia,odynophagia,Chest
pain,hematemesis
Diagnosis:Endoscopy,Culture,Biospy
Treatment: Acyclovir 400mg 5times in a day,
for 14-21days Foscarnet 90mg/kg Bid 2-3w
Ganciclovir 5mg/kg Bid
Glucocorticoids or thalidomide
Fungalesophagitis
Candida
Syptoms:dysphagia,odynophagia
Diagnosis:filling defect ,grape
clusters,yellow and white patchy plaques
in endoscopy yeast or hyphaloform
Treatment:fluconazole 200 state then
100mg OD for 7d Amphotericin B 10-
15mg qid for 7 Nystatin 10-20ml
suspension Qid
16. OTHER TYPE OF ESOPHAGEAL DISORDER
Radiation
esphagitis
Doxorubicin,Bleomycin
,Cisplantin
Stymptoms are
dysphagia and
odynophagia
Treatment :viscous
lidocaine,indomethacin
Corrosive
esophagitis
Caustic agent
Dilator is for opening
strictures
Pill induced
esophagitis
NSAIDs:Aspirin, Naproxen ,Ibuprofen
Biphosphonates:Aldendronate,Etidronat
e ,pamidronate
Antiviral
drugs:Nelfanavir,Zidovudine,Zalcitibine
Antibiotics:Tetracycline,doxyxyline,Clinda
mycin,pencillins
Chemotherapeutic agent;Doxurubicin
,bleomycin,Cisplantin
Others:
Theophylline,multivitamin,vitamin
C,KCL,ferrous sulfate
17. ESOPHAGEAL
DIVERTICULA
است مری جدار زدگی بیرون از عبارت
I. Zenkers diverticulum
Location: posterior hypopharyngeal wall
Symptoms: Halitosis, Dysphagea ,
esophageal obstruction, regurgitation of saliva
I. Epiphrenic diverticula
Rarely casue symptoms
I. Diffuse intramural diverticulosis
cause strictures and chronic candidiasis
Treatment
Diverticulectomy
18. ESOPHAGEAL WEBS
AND RINGS
Either Inflammatory or
congenital
Affects 10% of people
The only symptoms is
Episodic dysphagia to solids
Contractile ring عضلی حلقه
Schatzki ringمخاطی حلقه
20. EOSINOPHILLIC
ESOPHAGITIS
Allergens & Antigens
Clinical findings:
Heartburn,Dysphagia
Children:Abdominal pain,Chest Pain,🤮vomiting
Laboratory findings:
o Eosinophilia
o IGE level is high
o Barium radiography shows multiple concentric rings
o Endoscopy,Biopsy,Histology
o Tests for allergen
Treatment
PPI BID
Avoid Eggs,Walnut,Soya,Wheat
Corticosteroids:Budesonide,futicasone