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