GI For Rehabilitation

I. Diseases of Esophagus

A.Esophagitis = Reflux of gastric contents into the lower esophagus is the most frequent cause of esophagitis -Is the most common outpatient gastrointestinal diagnosis in the United States. - The associated clinical condition is termed gastroesophageal reflux disease (GERD) .

- Rarely, chronic GERD is punctuated by attacks of severe chest pain that may be mistaken for heart disease. - Treatment with proton pump inhibitors reduces gastric acidity and typically provides symptomatic relief.

Complications of reflux esophagitis include: Esophageal ulceration Hematemesis

4. Melena 5. Stricture development 6. Barrett esophagus.

B. Barrett Esophagus Is a complication of chronic GERD that is characterized by a. Intestinal metaplasia within the esophageal squamous mucosa.

The incidence of Barrett esophagus is rising It is estimated to occur in as many as 10% of persons with symptomatic GERD. White males are affected most often and typically present between 40 and 60 years of age.

Note: The greatest concern in Barrett esophagus is that it confers an increased risk of esophageal adenocarcinoma. , it should be noted that most persons with Barrett esophagus do not develop esophageal cancer.

II. Diseases of Stomach

A. Acute Gastritis - Is a transient mucosal inflammatory process that may be asymptomatic or cause variable degrees of epigastric pain, nausea, and vomiting.

a. Mucosal erosion b. Ulceration c. Hemorrhage - In more severe cases , there may be : a. Mucosal erosion b. Ulceration c. Hemorrhage

d. Hematemesis e. Melena f. Rarely, massive blood loss

B. Acute Peptic Ulceration - Focal, acute peptic injury is a well-known complication of therapy with NSAIDs as well as severe physiologic stress. -

Such lesions include Stress ulcers -Most commonly affecting Critically ill patients with 1.Shock 2.Sepsis 3. Severe trauma

b. Curling ulcers, - Are associated with severe burns or trauma Occurring in the proximal duodenum

C. Cushing ulcers, - Arising in persons with intracranial disease Arising in the stomach, duodenum, or esophagus Have a high incidence of perforation

Clinical Features a.Nausea b. Vomiting c. Coffee-ground hematemesis. d. Bleeding from superficial gastric erosions

or ulcers that may require transfusion Other complications, including perforation, can also occur

C. Chronic Gastritis The symptoms and signs are less severe but more persistent than those of acute gastritis. Nausea and upper abdominal discomfort may occur, sometimes with vomiting, but hematemesis is uncommon.

- The most common cause of chronic gastritis is infection with the bacillus Helicobacter pylori

a. Helicobacter pylori Gastritis -These curved bacilli are present in gastric biopsy specimens from almost all patients with duodenal ulcers and a majority of those with gastric ulcers or chronic gastritis.

Note - Acute H. pylori infection does not produce sufficient symptoms to require medical attention in most cases

H. pylori organisms are present in 90% of patients with chronic gastritis affecting the antrum. H. pylori infection also confers increased risk of gastric cancer

Epidemiology In the United States, H. pylori infection is associated with poverty, household Effective treatments include combinations of antibiotics and proton pump inhibitors

Patients with H. pylori gastritis usually improve after treatment Although relapses can follow incomplete eradication or reinfection.

Autoimmune gastritis, a.the most common cause of atrophic gastritis, represents less than 10% of cases of chronic gastritis b. and is the most common form of chronic gastritis in patients without H. pylori infection. c. Less common causes include radiation injury and chronic bile reflux.

b. Autoimmune Gastritis - Accounts for less than 10% of cases of chronic gastritis. - In contrast with that caused by H. pylori, autoimmune gastritis typically spares the antrum and induces hypergastrinemia

Note: -Autoimmune gastritis is characterized by Antibodies to parietal cells and intrinsicfactor that can be detected in serum and gastric secretions

- Reduced serum pepsinogen I levels - Antral endocrine cell hyperplasia - Vitamin B12 deficiency -Defective gastric acid secretion (achlorhydria)