Download - K16 - Dyspepsia and GERD

8/12/2019 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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