The esophagus, stomach and part of duodenum form the foregut structures. Esophagitis is the inflammation of mucosa of the esophagus. Gastroduodenal disorders include many commonly encountered disorders like dyspepsia and peptic ulcer.
Disorders of esophagus
Esophagus or the food pipe is a hollow organ which propels food to the stomach. It is about 25 cm in length. It starts at about 15 cm from the lower incisor teeth and ends at the gastroesophageal junction which is about 40 cm from the lower incisor teeth. The following are some of the common esophageal disorders.
Gastroesophageal reflux disease
Gastroesophageal reflux disease is the most common condition affecting the esophagus. Gastroesophageal reflux occurs physiologically in all persons, when contents of stomach reflux into the esophagus. It is called gastroesophageal reflux disease when the reflux produces esophageal and/or extraesophageal symptoms or causes damage to the esophagus or other organs.
The common symptoms of gastroesophageal disease include heartburn, regurgitation, difficulty in swallowing, nausea and belching. Other less common symptoms include chest pain, cough, hoarseness of voice, feeling of lump in the throat, dental erosion and sore throat.
The treatment of gastroesophageal reflux disease includes:
Esophagitis
Esophagitis is a condition characterized by inflammation of mucosa (inner lining) of the esophagus. The esophagitis symptoms include chest pain and pain while swallowing. The esophagitis treatment depends on the underlying cause. Some of the causes of esophagitis are:
Gastroesophageal reflux disease
Recurrent reflux of acid contents from the stomach causes inflammation of the mucosa of esophagus resulting in esophagitis. The acid reflux related esophagitis symptoms include heartburn, regurgitation, difficulty and pain during swallowing. The acid reflux induced esophagitis treatment includes medications like proton pump inhibitors and lifestyle modifications as mentioned above.
Infection
Esophageal infection resulting in esophagitis commonly occurs in those with suppressed immune system. The common infections causing esophagitis are Candida, herpes simplex and mycobacterium tuberculosis. Treatment depends on the cause. Candida infection is treated with antifungal medications like fluconazole. Herpes is treated with acyclovir. Tuberculosis is treated with anti-tuberculous medications.
Medication induced
Medication induced esophagitis or the pill esophagitis can occur at any age. Some of the medications that are commonly associated with esophagitis are tetracycline, nonsteroidal anti-inflammatory drugs, ferrous sulphate and medications used in the treatment of cancer. Pill esophagitis treatment consists of proper administration of medication helps to prevent pill esophagitis. Medications should be swallowed with at least 8 ounces of clear liquid. Patients should remain upright for at least 30 minutes following ingestion of medication.
Radiation induced
Esophagitis can occur in the second or third week of standard thoracic radiotherapy. The affected patients develop esophagitis symptoms like difficulty and pain during swallowing. Symptoms may persist for many weeks after completion of high dose radiotherapy. The late complication includes narrowing of the esophagus.
Gastroduodenal disorders
The stomach is a “J” shaped canal which is continuous with the esophagus above and duodenum below. Its function includes storing large quantities of recently ingested food, initiating the digestive process and releasing its contents in a controlled fashion in to the duodenum which has a smaller capacity.
The duodenum is the first part of small intestine. It is continuous with the stomach above and the jejunum below. The liver and the pancreas are connected to duodenum through the bile duct and the pancreatic duct respectively which open in to a common channel to enter the duodenum. Most of the digestion of food takes place in the duodenum
The gastroduodenal disorders can be organic or functional. The gastroduodenal disorder symptoms are mostly nonspecific. The gastroduodenal disorder symptoms include upper abdominal pain or discomfort, nausea, vomiting and abdominal bloating. The gastroduodenal disorder treatment depends on whether it is functional or organic. The common gastroduodenal disorders include the following.
Functional dyspepsia
Functional dyspepsia refers to persistent or recurrent dyspepsia in patients who have undergone tests including endoscopy and have not been found to have an obvious specific cause of their symptoms. Dyspepsia is defined as pain or discomfort centered in the upper abdomen. The symptoms of this gastroduodenal disorder include:
The treatment of functional dyspepsia includes:
Belching disorder
During eating and drinking some amount of air is swallowed which is belched out and this is considered a normal phenomenon. Belching is considered a disorder only when it is troublesome. Belching may accompany gastroesophageal reflux disease and dyspepsia. The treatment of belching disorder includes-
Nausea and vomiting disorders
Nausea is the unpleasant sensation of impending vomiting felt in the upper abdomen or throat. Vomiting is forceful expulsion of stomach or intestinal contents through the mouth associated with contraction of abdominal and chest muscles. This group includes chronic idiopathic nausea, functional vomiting and cyclic vomiting syndrome.
A person is said to be suffering from chronic idiopathic nausea if he has bothersome nausea occurring several times a week in the last three months and the tests done for metabolic diseases and endoscopy does not reveal anything.
Functional vomiting is diagnosed:
Cyclic vomiting syndrome is diagnosed with the following criteria
The treatment includes:
Rumination syndrome
Rumination syndrome is a disorder characterized by repeated regurgitation of recently ingested food which is followed chewing and swallowing of the food again. It can occur in both males and females of all ages. Rumination starts within minutes of starting a meal. There will no nausea or retching. Each episode lasts for 1-2 hours. The food that is regurgitated is partially digested.
Treatment of rumination syndrome includes:
Gastritis and gastropathies
Gastritis is a condition characterized by inflammation of the inner lining of the stomach. The various symptoms of this gastroduodenal disorder are pain in the upper abdomen, nausea, vomiting and bleeding. Gastropathies are disorders characterized by erosions and other defects of the inner lining of the stomach without features of inflammation and cause symptoms like upper abdominal pain, nausea and vomiting. The various causes of gastritis and gastropathies are:
The treatment of gastritis and gastropathies depends on the underlying condition. Ingestion of green tea is also found to reduce the risk of gastritis.
Peptic ulcer
Peptic ulcer is a common gastroduodenal disorder that affects individuals all around the world. An ulcer is a defect in the inner lining of the gastrointestinal tract. It could be either a gastric ulcer or a duodenal ulcer. The two most common causes of peptic ulcer are Helicobacter pylori infection and intake of non-steroidal anti-inflammatory drugs which are used as pain killers. The other causes of peptic ulcer includes medications used for chemotherapy, medications used for osteoporosis like alendronate, conditions like Zollinger Ellison Syndrome which is characterized by increased secretion of acid in the stomach.
Peptic ulcer can be confirmed with upper gastrointestinal endoscopy. Treatment of peptic ulcer includes the following –
Sunday, May 2, 2010
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