GI Disorders

-Backflow of stomach acid into the esophagus.

• - Pyrosis
• - Regurgitation, bitter sour/bitter taste
• - Tooth erosion
• - Hoarseness
• - Eructation
• - Flatulence
• - Dysphagia
• - Odynophagia
• - Nocturnal cough
• - Wheezing

- Heartburn: burning & pressure sub sternal and retrosternal, radiates up neck, jaw and back. Mimics angina.

-Post meal: 20 min � 2 hrs after meals

- Belching

� Reflux salivary hyper-secretion that does not taste bitter.

� Difficulty swallowing

� Painful swallowing

• -Usually diagnosed by symptoms
• - Bernstein Test: + if pain if felt when HCL is applied to esophagus
• - Esophagogastroduodenoscopy (EGD)
• - Barium swallow (upper GI series) : identifies hiatal hernia

• - Teach Diet & lifestyle changes
• - Avoid problem foods / beverages
• - Stop smoking
• - Eat 4-6 smaller meals
• - Lose weight
• - Eliminate alcohol
• - Remain upright 1-2 hrs after meals
• - Avoid tight clothing
• - Medication therapy
• Antacids
• H2 receptor antagonists
• Proton pump inhibitors
• -Fundoplication

-aluminum hydroxide, Mylanta

• - cimetidine, Tagament
• - ranitidine, Zantac
• - famotidine, Pepcid
• - nizatidine, Axid

• - omeprazol, Prilosec
• - esomeprazole, Nexium
• - pantoprazol, Protonix
• - rabeprazol, Aciphex
• - lansoprazole, Prevacid

- secralfate, Carafate

• - metoclopramide, Reglan :
• - increases peristalsis therefore, promotes gastric emptying & reduces risk of GERD

- surgery to strengthen the LES and lessen the possibility of acid reflux also done to correct hiatal hernia.

• - Barrett�s esophagus: Normal squamous epithelium is replaced w/columnar epithelium, increasing risk of esophageal cancer
• - Can trigger Asthma attacks
• - Chest pain resulting in bleeding
• - Narrowing or chronic irritation of esophagus

• - Can cause esophageal ulcerations and hemorrhage
• - Risk for aspiration
• - Increased risk for Adenocarcinoma
• - Scarring can permanently damage esophagus tissue & produce stricture

- Cardiospasm: an abnormal condition characterized by the inability of a muscle to relax, particularly the cardiac sphincter of the stomach.

• - Dysphagia
• - Regurgitation

• - Esophagoscopy
• - Radiologic studies: show esophageal dilation
• - Manometry: shows absence of primary peristalsis

• - Drug Therapy: to reduce pressure in the LES
• -Anticholinergics
• - Nitrates
• - Calcium channel blockers
• - Dilation with balloon similar to PCTA
• - Cardiomyotomy: incision in the muscle layer of the esophagus allowing expansion
• - High calorie, high protein diets.

• - A protrusion of the stomach and other abdominal viscera through an opening, or hiatus in the diaphragm, results of a weakness of the diaphragm.
• - Anatomical condition not a disease
• - Treated by fundoplication

• - GERD
• - Strangulation of the herniated organ
• - Infarction
• - Ulceration