Heartburn

Abdullah 55 years old Male, Complaining of Chest discomfort for several months, difficulty Swallowing, Weight loss, and diagnosed with Barret’s Esophagus
Anatomy
1. Esophagus
2. Stomach
Swallowing
1. Definition: the entire act of deglutition from placement of food in the mouth through the oral and pharyngeal stages of the swallow until the material enters the esophagus through the cricopharyngeal juncture.
2. phases:
  1. 1-Voluntary phase
  2. 2-Pharyngeal phase
  3. 3-esophageal phase
Gastric Acid Secretion
Differential Diagnosis of dysphagia
1. Oropharyngeal dysphagia
  1. Neurological disorders
    1. Cerebrovascular accident
    2. Parkinson’s disease
    3. Degerenrative diseases
    4. Postinfectious
    5. Peripheral neuropathy
  2. Muscular disorders
    1. Polymyositis
    2. Dermatomyositis
    3. Muscular dystrophy
    4. Cricopharyngeal achalasia
  3. Motor-end-plate disorders
    1. Myasthenia gravis
  4. Obstructive Lesions
    1. Tumors
    2. eosinophilic esophagitis
    3. Zenker’s diverticulum
  5. Congenital Anomalies
    1. Cerebral palsy
    2. Cleft lip and palate
2. Esophageal Dysphagia
  1. Neuromuscular disorders
    1. Scleroderma
    2. Achalasia
    3. Spastic motor disorders
  2. Obstructive Lesions
    1. Vascular compression
    2. Esophageal webs
    3. Schatzki’s ring
  3. Mediastinal Masses
    1. Lymphadenophathy
    2. Substernal thyroid
  4. GERD
    1. Causes
      1. LES decreased tone
      2. Hiatal Hernia
      3. abnormal peristalysis
      4. Abnormally slow emptying of stomach
      5. fatty foods, spicy foods, chocolate, caffeine, onions, tomato, sauce, carbonated beverages, mint, large meals and alcohol
      6. Medications
        sedatives
        tranquilizers
        calcium channel blockers
    2. DIAGNOSIS
      1. Upper endoscopy
      2. Ambulatory acid (pH) probe test
      3. Esophageal manometry
      4. X-ray
    3. Risk Factors
      1. Obesity
      2. Asthma
      3. Diabetes
      4. Peptic Ulcer
      5. Connective tissue disorders
      6. Zollinger-Ellison Syndrome
      7. Bad diet
      8. Cigarette smoking
      9. Aging
      10. Alcohol
      11. Increased histamine release
      12. Increased gastric infections
    4. signs and symptoms
      1. heartburn
      2. Chest pain
      3. Difficulty swallowing
      4. Regurgitation of food or sour liquid
      5. Sensation of a lump in your throat
    5. Complications
      1. bleeding
      2. strictures
      3. perforation
      4. barret esophagus
        Definition: metaplastic replacement of the normal squamous epithelium of the lower oesophagus by columnar epithelium.
        Diagnosis
        endoscopy
        histological examination of biopsies
    6. Management
      1. Lifestyle modifications
        Elevation of bed head
        Weight loss
        Avoid
        Smoking
        Alcohol
        Fatty meal, chocolate, onion, tea, coffee
        Spicy foods, citrus & tomato products
        Drugs that decrease LES pressure
        Small frequent meals
        No eating 3 hrs before sleeping
      2. Medical Treatment
        H2 Receptor antagonists
        Proton Pump inhibitors
        Misoprostol
        Sucralfate
        Antacids
        anti-muscarinic
Helicobacter Pylori
1. Gram-negative, microaerophilic bacterium
2. it causes
  1. gastritis
  2. peptic ulcers
  3. stomach cancer
3. Signs and Symptoms
  1. An ache or burning pain in your abdomen
  2. Abdominal pain
  3. Nausea
  4. Loss of appetite
  5. Frequent burping
  6. Bloating
  7. Unintentional weight loss
4. Risk Factors
  1. Living in crowded conditions
  2. Living without a reliable supply of clean water
  3. Living in a developing country
  4. Living with someone who has an H. pylori infection
5. Diagnosis
  1. Blood and stool tests
  2. Urea breath test
  3. Upper gastrointestinal endoscopy
  4. Upper GI tests
  5. CT Scan
6. Treatment
  1. Triple Therapy
    1. Two antibiotics and a proton pump inhibitor
Neoplasms of the Esophagus
1. SSC
2. Adenocarcenoma
  1. Intestinal type
  2. Diffuse type
3. Gastric polyps
4. Gastric lymphoma

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