Peptic ulcer disease Disorders of the esophagus

Similar documents
GASTROINTESTINAL AND ANTIEMETIC DRUGS. Submitted by: Shaema M. Ali

KK College of Nursing Peptic Ulcer Badil D ass Dass, Lecturer 25th July, 2011

CHAPTER 18. PEPTIC ULCER DISEASE, SELF-ASSESSMENT QUESTIONS. 1. Which of the following is not a common cause of peptic ulcer disease (PUD)?

National Digestive Diseases Information Clearinghouse

Copy right protected Page 1

Reflux of gastric contents, particularly acid, into the esophagus

Helicobacter 2008;13:1-6. Am J Gastroent 2007;102: Am J of Med 2004;117:31-35.

Proton Pump Inhibitors Drug Class Prior Authorization Protocol

Peptic ulcer disease. Nomin-Erdene. D SOM-531

MANAGEMENT OF DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD)

PEPTIC ULCER DISEASE JOHN R SALTZMAN, MD. Director of Endoscopy Brigham and Women s Hospital Professor of Medicine Harvard Medical School

Policy Evaluation: Proton Pump Inhibitors (PPIs)

Heartburn, also referred to acid reflux, happens when stomach acid flows back (refluxes) into your esophagus.

Gastro-oesophageal reflux disease and peptic ulcer disease. By: Dr. Singanamala Suman Assistant Professor Department of Pharm.D

A. Incorrect! Histamine is a secretagogue for stomach acid, but this is not the only correct answer.

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT OF DYSPEPSIA

GI Pharmacology. Dr. Alia Shatanawi 5/4/2018

ESOPHAGEAL CANCER AND GERD. Prof Salman Guraya FRCS, Masters MedEd

Chapter 63 Drugs Used in the Treatment of Gastrointestinal Diseases

QUICK QUERIES. Topical Questions, Sound Answers

Chapter 14: Training in Radiology. DDSEP Chapter 1: Question 12

Second term/

GI Pharmacology. Dr. Alia Shatanawi 5/4/2018

Management of Dyspepsia

GASTROINTESTINAL SYSTEM MANAGEMENT OF DYSPEPSIA

Peptic Ulcer Disease Update

- Ali Yaghi. - Sara Yaghi. - Alia Shatnawi. 1 P a g e

Oesophageal Disorders

Lab:2 Drugs acting on Gastrointestinal tract

GI update. Common conditions and concerns my patients frequently asked about


Drug Class Monograph

Management of dyspepsia and of Helicobacter pylori infection

Peptic ulcer disease: an update on diagnosis and treatment

Fecal incontinence causes 196 epidemiology 8 treatment 196

SASKATCHEWAN REGISTERED NURSES ASSOCIATION

Epidemiology of Peptic Ulcer Disease


Rpts. GENERAL General Schedule (Code GE) Program Prescriber type: Dental Medical Practitioners Nurse practitioners Optometrists Midwives

Helicobacter Pylori Testing HELICOBACTER PYLORI TESTING HS-131. Policy Number: HS-131. Original Effective Date: 9/17/2009

Proton Pump Inhibitors. Description. Section: Prescription Drugs Effective Date: July 1, 2014

Treatment of Helicobacter pylori Infection

PPIs: Good or Bad? 1. Basics of PPIs. Gastric Acid Basics. Outline. Gastric Acid Basics. Proton Pump Inhibitors (PPI)

FEDERAL BUREAU OF PRISONS CLINICAL PRACTICE GUIDELINES GASTROESOPHAGEAL REFLUX DISEASE (GERD) DYSPEPSIA, AND PEPTIC ULCER DISEASE, NOVEMBER, 2001

Omeprazole 10mg. Name, Restriction, Manner of administration and form OMEPRAZOLE omeprazole 10 mg enteric tablet, 30 (8332M) Max. Qty.

Gastroesophageal Reflux Disease, Paraesophageal Hernias &

Speaker disclosure. Objectives. GERD: Who and When to Treat 7/21/2015

SARCINA VENTICULARI IS A POSSIBLE CAUSATIVE MICROORGANISM OTHER THAN H.PYLORI IN GASTRIC OUTLET OBSTRUCTION PATHOGENESIS

11/19/2012. Comparison between PPIs G CELL. Risk ratio (95% CI) Patient subgroup. gastrin. S-form of omeprazole. Acid sensitive. coated.

Index. Note: Page numbers of article titles are in boldface type.

Management of Patients With Gastric and Duodenal Disorders

Treatment Options for GERD or Acid Reflux Disease A Review of the Research for Adults

MECHANISMS OF HUMAN DISEASE: LABORATORY SESSIONS GASTROINTESTINAL (GI) PATHOLOGY LAB #1. January 06, 2012

OPEN ACCESS TEXTBOOK OF GENERAL SURGERY

Putting Chronic Heartburn On Ice

Peptic Ulcer Disease and NSAIDs

Drugs Affecting the Gastrointestinal System. Antacids, Constipation, Increasing gastrointestinal motility

National Digestive Diseases Information Clearinghouse

High use of maintenance therapy after triple therapy regimes in Ireland

Acid-Peptic Diseases of the Stomach and Duodenum Including Helicobacter pylori and NSAIDs Prof. Sheila Crowe

COMPUS OPTIMAL THERAPY REPORT. Supporting Informed Decisions. À l appui des décisions éclairées

Effective Health Care

UPPER GI DISEASES 11/15/2014. Lesson Objectives. GI Tract Review. NUTR 2050 Nutrition for Nursing Professionals. Mrs. Deborah A. Hutcheon, MS, RD, LD

A Trip Through the GI Tract: Common GI Diseases and Complaints. Jennifer Curtis, MD

GERD, peptic ulcer disease, and celiac disease: updates from the upper GI tract

Rpts. GENERAL General Schedule (Code GE)

235 60th Street, West New York, NJ T: (201) F: (201) Main Street, Hackensack, NJ T: (201)

Myogenic Control. Esophageal Motility. Enteric Nervous System. Alimentary Tract Motility. Determinants of GI Tract Motility.

Esophageal Motility. Alimentary Tract Motility

Management of dyspepsia in adults in primary care

Gastrointestinal Disorders. Disorders of the Esophagus 3/7/2013. Congenital Abnormalities. Achalasia. Not an easy repair. Types

PLANNING COMMITTEE. Seek simplicity, and mistrust it. Alfred North Whitehead

David Markowitz, MD. Physicians and Surgeons

Pharmacology. Drugs that Affect the Gastrointestinal System

Gastroesophageal Reflux Disease (GERD)

Heartburn Overview. Causes & Risk Factors

Gastritis General standpoints

Helicobacter pylori 幽門螺旋桿菌 馬偕紀念醫院新竹分院一般內科, 肝膽腸胃科陳重助醫師

National Digestive Diseases Information Clearinghouse

Guidelines for the Management of Dyspepsia and GORD. Gastroenterology/ Acute Adult Governance. Drugs and Therapeutics Committee

Peptic ulcer disease 1 GIT. Dr Kawa Ahmad PhD Pharmaceutics

Drug Class Literature Scan: Proton Pump Inhibitors and Histamine-2 Receptor Antagonists

DYSPEPSIA Dyspepsia indigestion during or after eating Full Heat, burning or pain Note: one of every four people

ESOPHAGEAL MOTOR DISORDERS

Summary of Findings on the Prescribing and Use of Proton Pump Inhibitors. COMPUS Interim Report CCOHTA. March 6, 2006

Abdominal Pain in a Young Aviator

What Is Peptic Ulcer Disease?

-Mohammad Ashraf. -Anas Raed. -Alia Shatnawi. 1 P a g e

PATIENT HISTORY FORM

Class Update: Proton Pump Inhibitors and Histamine 2 Receptor Antagonists

Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment)

OSPAP Programme. Gastrointestinal Drugs. Dr. Adrian Moore Dale

Zollinger-Ellison Syndrome

INVESTIGATIONS OF GASTROINTESTINAL DISEAS

GERD DIAGNOSIS & TREATMENT DISCLOSURES 4/18/2018

June By: Reza Gholami

9/18/2015. Disclosures. Objectives. Dysphagia Sherri Ekobena PA-C. I have no relevant financial interests to disclose I have no conflicts of interest

Proton Pump Inhibitors. Description

Transcription:

Peptic ulcer disease Disorders of the esophagus

Peptic ulcer disease Burning epigastric pain Exacerbated by fasting Improved with meals Ulcer: disruption of mucosal integrity >5 mm in size, with depth to the submucosa Helicobacter pylori Duodenal ulcers Gastric ulcers malignancy

Pathophysiology NSAID, Aspirin Helicobacter pylori Gastric acid secretion : duodenal ulcer Gastric acid secretion : gastric ulcer H. pylori MALT (mucosal-associated lymphoid tissue) lymphoma H. pylori gastric adenocarcinoma Cigarette smoking Blood group O Stress Glucocorticoids Clopidogrel

Clinical Features History: abdominal pain Careful history taking and physical examination Hunger pain Relived by antacids or food Nausea, vomiting Sudden severe pain perforation Tarry stools or coffee-ground emesis bleeding

Physical Examination Epigastric tenderness Severely tender, boardlike abdomen perforation Tachycardia, orthostasis dehydration vomiting or active GI bleeding

Complications GI bleeding Perforation Gastric outlet obstruction in the peripyloric region endoscopic balloon dilation őr surgical intervention Malignant transformation

Differential Diagnosis Gallbladder stones Gastroesophageal reflux Acute/chronic pancreatitis Crohn s disease Functional dyspepsia

Diagnostic Evaluation Barium enema double-contrast study Endoscopy and tissue biopsy: direct visualization of the mucosa, detection of H. pylori Urea breath test for detection of H. pylori

Treatment Acid-suppressing drugs Antacids: Aluminum hydroxide, Magnesium hydroxide, Sodium bicarbonate, Maalox, Mylanta, Tums H2 receptor antagonists: Cimetidine, Ranitidine, Famotidine, Nizatidine Proton pump inhibitors: Omeprazole, Lansoprazole, Rabeprazole, Pantoprazole, Esomeprazole Mucosal cytoprotective agents: Sucralfate, Prostaglandine analogue Misoprostol, Bismuth-containing compounds

Regimens recommended for eradication of H. pylori infection 1. Bismut subsalicylate+ Metronidazole + Tetracycline 2. Ranitidine bismuth citrate+ Tetracycline+ Clarithromycin or Metronidazole 3. Omeprazole+ Clarithromycin + Metrodizale or Amoxicillin

Quadruple Therapy Omepratole+ Bismuth subsalicylate+ Metronidazole+ Tetracycline Duration of treatment:14 days Initial eradication rates: 80-85%

Recommendations for treatment of NSAID-related mucosal injury Active ulcer: NSAD discontinued + H2 receptor antagonist or PPI Active ulcer: NSAID continued PPI Prophylactic therapy: PPI H. pylori infection: eradication if active ulcer present or there is a past history of peptic ulcer disease

Surgical therapy Urgent: for the treatment of an ulcer-related complication Nasogastric suction Endoscopic intervention with balloon dilation Vagotomy and drainage (gastroduodenostomy) gastric acid secretion Highly selective vagotomy Vagotomy with antrectomy Laparoscopic surgery Billroth I: gastroduodenostomy Billroth II: gastrojejunostomy

Zollinger-Ellison syndrome Gastrin Multiple peptic ulcers Gastric acid output hypersecretion Diarrhea Tumor: gastrinoma Tumor localization: Ultrasound, CT scan, MRI, Octreoscan Treatment: total gastrectomy

Diseases of the Esophagus Symptoms: dysphagia, heartburn or pyrosis, odynophagia or painful swallowing, esophageal chest pain or atypical chest pain Regurgitation: appereance of gastric contents in the mouth Chronic cough Laryngeal aspiration Aspiration pneumonia

Diagnostics tests Radiologic studies barium swallow, double-contrast esophagogram Esophagoscopy+ biopsy

Achalasia Motor disorder of the esophageal smooth muscle lossof intramural neurons No peristaltic contractions Clinical features: dysphagia, regurgitation, weight loss Diagnosis: barium swallow esophageal dilation, no peristalsis in the lower twothird of the esophagus Treatment: balloon dilatation, Heller s extramucosal myotomy

Gastroesophageal Reflux Disease GERD Frequency: 15% Heartburn and regurgitation backflow of gastric acid into the esophagus and mouth Incompetent barriers at the gastroesophageal junction Reflux esophagitis, peptic stricture Angina-like or atypical chest pain Esophagoscopy

Treatment of GERD H2 receptor blocking agents: Cimetidine, Ranitidine, Famotidine, Nizatidine PPIs: Omeprazole, Lansoprazole, Pantoprazole, Esomeprazole, Rabeprazole Duration: 8 weeks PPI: 30 min before breakfast

Barret s Esophagus Metaplasia of esophageal sguamous epithelium to columnar epithelium Complication of severe GERD Risk for esophageal adenocarcinoma

Candida Esophagitis Odynophagia, dysphagia Oral thrush Endoscopy: small, yellow-white raised plaques C. albicans Treatment: Fluconazole orally, Itraconazole