Mouth & Salivary Glands Diseases of the Mouth & Salivary Glands

Causes of Oral Ulceration Aphthous: Idiopathic Pre-menstrual Infection: Fungal e.g. Candidiasis Bacterial e.g. Vincent’s angina, Syphilis Viral e.g. herpes simplex GIT diseases: Crohn’s disease Celiac disease Dermatological conditions: Lichen planus dermatitis herpetiformis Pemphigus erythema multiformi Pemphegoid

Causes of Oral Ulceration - cont. Drugs: Hypersensitivity e.g. Steven’s Johnson syndrome NSAID losartan ACE inhibitor cytotoxic Systemic diseases: SLE Behcet’s disease Neoplasia: Carcinoma Leukemia Kaposi’s Sarcoma

Oral ulceration in patient with aplastic anemia

Aphthous ulceration

Deep ulcers in patient with Behcet Disease

Oral thrush

Chronic oral candidiasis Acute oral candidiasis

Herpes Simplex

Angular Stomatitis & atrophic glossitis in patient with IDA

Stevens Johnson’s syndrome

Lichen planus

Peutz Jegher syndrome

Scurvy

Gingival hypertrophy due to phenytoin therapy

Lead poisoning

Yellow staining of teeth due to Tetracyclin therapy

Gastro-Esophageal Reflux Disease

Gastro-Esophageal Reflux Disease (GERD): Definitions Gastro-Esophageal Reflux Disease (GERD): It is a chronic disorder which describes any symptomatic or histopathologic alteration resulting from episodes of gastro-duodenal reflux into the esophagus and/or adjacent organs more than twice/week for more than 2 months

ERD NERD Erosive Reflux Disease Non Erosive Reflux Disease 2/3 Definitions ERD Erosive Reflux Disease 1/3 NERD Non Erosive Reflux Disease 2/3

Typical: Symptoms Heartburn Acid regurgitation > 2x/week > 4 to 8 weeks

Symptoms-Atypical Esophageal: Pulmonary: Non-cardiac chest pain Non-obstructive dysphagia Globus hystericus Pulmonary: Asthma Chronic cough Hemoptysis Bronchitis Bronchiectasis Recurrent pneumonia

Symptoms-Atypical Otorhinolaryngological: Oral Hoarseness Throat cleaving laryngitis Sinusitis Otolagia Oral Etching of dental enamel Halitosis

Epidemiolgy

Shubbar & Taka

Increasing Prevalence: 1976 15% 1988 44%

Pathogenesis Transient lower esophageal sphincter (LES) relaxation Hypotensive LES Delayed Esophageal clearance Delayed gastric emptying Salivary function Tissue resistance

Diagnosis

1-History Age Alarm features Nocturnal reflux Dysphagia Odynophagia Weight loss GI bleeding Nausea &/or vomiting Family history of cancer Nocturnal reflux

-ve endoscopy is seen in 2/3 of GERD Useful in: Grading Hiatus hernia Ulcer or stenosis Barrett’s Esophagus Indications: Age over 40 years-old Alarm features Atypical symptoms -ve endoscopy is seen in 2/3 of GERD

24 hrs pH Recording Indications: Atypical symptoms NERD who do not respond to PPI When esophagitis is not demonstrated in the pre-operative endoscopic examination . IMPEDANCE testing

Management

Symptoms Antacids/Alginates Proton pump inhibitor Full dose Poor response Consider pH Monitoring Reconsider diagnosis Normal Fundoplication Maintenance dose Good response H2 receptor Antagonists Antacids

Behavioral modifications in the treatment of GERD Elevation of the headboard of the bed (15 cm) Ingestion of the following foods in moderation & based on symptom correlation: fatty foods, citrus, coffee, chocolate, alcoholic & carbonated beverages, mint, tomato-based products.

Behavioral modifications in the treatment of GERD Special care with at risk medications: anticholinergics, theophylline, tricyclic antidepressants, Ca channel blockers, B-Adrenergic agonists, alendronate. Avoidance of lying down for 2 hrs after meals Avoidance of large meals Drastic reduction in, or cessation of, smoking. Reduction of body weight if overweight

Surgical treatment Indications: No response to medical treatment including atypical symptoms. Continuous maintenance treatment is required especially in patients younger than 40 year old. Financial impediment

Complications Barrett’s esophagus Stenosis Ulcer Bleeding