K16 - Dyspepsia and GERD

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    Curriculum VitaeNama

    LahirAlamatIstriAnak/Mantu/CucuPendidikan

    Pekerjaan

    Pendidikan Tambahan

    :

    :::::

    :

    :

    I Gede Arinton

    Singaraja, 1 Januari 1950Jl. Pramuka 249 Purwokerto15/3/31. dr. umum FK. UNUD 19772. dr. SpPD FK. UNDIP 19873. MKom STIBBi Jkt 19994. MMR UNSUD 20055. KGEH FK. UI 20076. Doktor Ilmu Kedokteran UNDIP 2008Bag. Penyakit. Dalam RSUD. Margono

    Soekarjo/FKIK Unsud Purwokerto1. Pelatihan Endoscopy di RSU dr.

    Hasan Sadikin Bandung.2. International Endoscopy Workshop

    2007, Jakarta 5 7 April 2007.3. Training Endoscopy Showa

    University Yokohama 2009

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    Dx. & Management

    Dyspepsia-GERDDr.dr. I Gede Arinton,SpPD-KGEH

    The Internal Medicine of FKIK Unoed

    Purwokerto

    2014

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    IntroductionDyspepsia

    not a disease but a symptom complex

    The prevalence: 25% general pop.

    not a life-threatening disease

    not associated with an increased

    mortality rate

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    IntroductionDyspepsia

    But impact on patients and health care

    services -> seek medical help: quality of life -> reduced

    20% -> fear from possible malignancy

    Economic loss : > 50% ->medicamentous th/

    30% absence from work or school

    30-60% objective examinations : biochemical

    testing, endoscopic or radiologic studies

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    IntroductionGERD :

    the prevalence of at least monthly

    GERD symptoms : 26-44%.

    up to 20%, with an incidence rate

    C/ 15 20% -> 0.5% AdenoCa

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    Locke et al. Gastroenterology1997;112:1148.

    High Prevalence ofGastroesophageal Reflux

    Symptoms

    19.8%

    59%

    0%10%20%30%40%

    50%60%

    Weekly MonthlyFrequency of heartburn and/or

    regurgitation

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    DiagnosisDyspepsia

    Greek Dys = bad + Pepse =

    digestion : bad digestion

    Indigestion

    Rome II :

    pain or discomfort centered in the upper

    abdomen.

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    DiagnosisDyspepsia

    UnInvestigated

    Investigeted - Endos, BaEnema :

    Organic

    Functional - 60% Primary Practice.

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    Rome III :FUNCTIONAL DYSPEPSIA

    Dx. criteria* - One or more : Bothersome postprandial fullness

    Early satiation Epigastric pain Epigastric burning

    AND

    Endos- structural

    the last 3 months+ at least 6 months prior

    to diagnosis

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    Diagnosis

    GERD : heart burn or stomach

    material refluxing from the stomach

    into the esophagus

    Organic : ERD & Functional : NERD.

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    Rome III :Functional Esophageal

    Disorders A1. Functional Heartburn

    A2. Functional Chest Pain of Presumed

    Esophageal Origin

    A3. Functional Dysphagia

    A4. Globus

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    Acid Related Diseases

    Dyspepsia

    GERD

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    PathoPhysiology

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    Parietal cells

    Wolfe, 2006

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    GASTRIC ACID

    SECRETION Cephalic phase

    Gastric phase

    Intestinal phase

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    ExtraesophagealManifestations of GERD

    Pulmonary AsthmaAspiration

    pneumoniaChronic bronchitisPulmonary fibrosis

    Other Chest painDental erosion

    T HoarsenessLaryngitisPharyngitisChronic coughGlobus sensationDysphoniaSinusitisSubglottic

    stenosisLaryngeal cancer

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    Potential Oral and LaryngopharyngealSigns Associated with GERD

    Edema and hyperemia of

    larynx

    Vocal cord erythema,

    polyps, granulomas,

    ulcers

    Hyperemia and lymphoid

    hyperplasia of posterior

    pharynx

    Interarytenyoid changes

    Dental erosion

    Subglottic stenosis

    Laryngeal cancerVaezi MF, Hicks DM, Abelson TI, Richter JE. Clin Gastro Hep 2003;1:333-

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    Pathophysiology ofExtraesophageal GERD

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    Symptoms ofComplicated GERD

    Dysphagia

    Difficulty swallowing: food sticks or

    hangs up

    Odynophagia

    Retrosternal pain with swallowing

    Bleeding

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    Diagnostic Tests for

    GERD Barium swallow Endoscopy

    Ambulatory pH

    monitoring

    Esophageal

    manometry

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    Endoscopy Indications for

    endoscopy

    Alarm symptoms

    Empiric therapy failure

    Preoperative evaluation

    Detection of Barretts

    esophagus

    A b l t 24 h H

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    Ambulatory 24 hr. pHMonitoring

    Physiologic study

    Quantify reflux in

    proximal/distal

    esophagus % time pH < 4

    DeMeester score

    Symptom

    correlation

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    Ambulatory 24 hr. pH Monitoring

    Normal

    GERD

    Wireless Catheter Free Esophageal pH

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    Wireless, Catheter-Free Esophageal pHMonitoring

    Improved patientcomfort andacceptance

    Continued normal

    work, activities anddiet study

    Longer reportingperiods possible (48

    hours) Maintain constantprobe position relativeto SCJ

    Potential Advantages

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    Esophageal Manometry

    Assess LES pressure,

    location andrelaxation

    Assist placement of 24

    hr. pH catheter

    Assess peristalsis

    Prior to antireflux

    surgery

    Limited role inGERD

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    Management :

    ICSI algorithm

    Refer

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    Devlin et al,2005

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    Summary HCl secreted by the stomach is

    believed to play a crucial pathogenic

    role. The diagnostic algorithm in

    dyspepsia must be adjusted

    according to the a priori probability

    of relevant diagnosis

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    Summary

    A fundamental abnormality in GERD

    is excessive reflux of gastric

    contents across the EGJ.

    Dx. GERD - clinical history-

    challenge for even the most skilled

    clinician.

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