dr sharad malhotra consultant gastroenterologist, hepatologist and therapeutic endoscopist batra...

GLIMPSES OF GASTROENTEROLOGY

DR SHARAD MALHOTRACONSULTANT

GASTROENTEROLOGIST , HEPATOLOGIST AND

THERAPEUTIC ENDOSCOPISTBATRA HOSPITAL, NEW DELHI

FUNCTIONAL DYSPEPSIA

DefinitionCharacteristics:

Central abdomenPain or discomfortNot associated with bowel movements

No structural or biochemical abnormalty

Part of Gastroduodenal disorders (Rome II)

ClassificationOrganic dyspepsia

PUD, GERD, Pancreatico-billiry diseaseFunctional dyspepsiaUlcer-like dyspepsiea

PainDysmotility-like dyspepsia

Discomort; nausea, vomiting, postprandial fullness and upper abdominal bloating

Reflux-like dyspepsia Heartburn but not the predominant symptom

It occurs in approximately 25 percent of the population each year,

Most affected people do not seek medical care

Approach to the patient with dyspepsia

Alarm symptoms Unintended weight loss Persistent vomiting  Progressive dysphagia  Odynophagia  unexplained anemia or iron deficiency  Hematemesis  Palpable abdominal mass or lymphadenopathy  Family history of upper gastrointestinal cancer  Previous gastric surgery  Jaundice NPV=99%

Endoscopy

Advantage: Gold standard test to exclude gastroduodenal

ulcers, reflux esophagitis, and upper gastrointestinal cancers.

Beneficial because up to 40 percent of patients have an organic cause of dyspepsia.

It also provides reassurance to patients

CANCER- OFTEN DIAGNOSED LATE

GASTRO ESOPHAGEAL REFLUX DISORDERMYTH 1: WRONG FOOD IS THE SOLE

CAUSE OF GERD

MYTH 2: GERD PATIENTS SHOULD KEEP THE BED RAISED

MYTH 3: BODY WEIGHT DOES NOT MAKE A DIFFERENCE

MYTH 4: EXCESS ACID PRODUCTION CAUSES GERD

MYTH 5: GERD CAUSES ONLY COMPLICATIONS IN ESOPHAGUS

MYTH 6: TOO MUCH STRESS CAUSES GERD

MYTH 7 :GERD IS BEYOND TREATMENT

MYTH 8: ACID SUPPRESSING MEDICATIONS WILL IN RETURN CAUSE INDIGESTION

MYTH 9: GERD IS NOT A SERIOUS DISEASE

MYTH 10 : IF MEDICATIONS FAIL, NOTHING CAN BE DONE

Alcohol Use

? Do we ….

Alcohol: Our Most Primitive Intoxicant

Egypt (el-Guebaly N, el-Guebaly A, 1981, Int J Addict., 16:1207-21)barley beer is probably the oldest drink in the world with

its origin in Egypt prior to 4200 BC

China (McGovern et al., 2004, PNAS, 101:17593-17598)7000 BC - the production of a prehistoric mixed fermented

beverage of rice, honey and fruit (neolithic village of Jiahu in Henan province)

2000 BC- unique cereal beverages (Shang and Western Zhou Dynasties)

Drinking Patterns: Rates and RisksModerate Drinking

Most people abstain or drink moderately placing them at low risk for alcohol use

disorders. In general, Moderate Drinking is up to 2 drinks/day for men;

up to 1 drink/day for women (USDA/HHS Dietary Guidelines, 2005)

One drink: one 12-ounce can or bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled

spirits.

Nearly 3 in 10 U.S. adults engage in these high-risk drinking patterns1

Men: more than 14 drinks in a typical week

more than 4 drinks on any day

Women: more than 7 drinks in a typical week

more than 3 drinks on any day

1 Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

Drinking Patterns: Rates and Risks

High-Risk Drinking

Ancient Warnings About Alcohol and Harmful Use Through the Ages

1600-1050 BC - Downfall of Egyptian and Chinese Empires and Dynasties attributed to excessive alcohol use

460-320 BC- Grecian Scholars issued advisories on drunkenness and moderate drinking

Plato – No use under age 18, between 18-30 use in moderation, no restrictions for use by those older than 40

Aristotle and Hippocrates were both critical of drunkenness

11th Century AD - Simeon Seth, a physician in the Byzantine Court, wrote that drinking wine to excess caused inflammation of the liver, a condition he treated with pomegranate syrup

Grouse ?