Reflux esophagitis
MOTILITY disorder |
Definition:
- Complication of gastroesophageal disease (GERD = malfunction of LES)
- Oesophagus inflammation due to stomach acid reflux |
Mechanism:
- Abnormal lower esophageal sphincter (LES) relaxation → allowing the ascent of stomach acid into the esophagus damaging the lining → inflammation |
Pathophysiology:
Causes of excessive / prolonged LES relaxation
- 1°: Hiatal hernia (✴), foods (coffee, alcohol, chocolate, mint, citrus), drugs (Ca channel blockers, β-agonist, anti-cholinergics)
- 2°: scleroderma (autoimmune disorder), delayed gastric emptying |
Sx & Ssx:
- Barret's esophagus: pre-cancerous lesion
- Bright red hematemesis: blood in vomit
- Mechanical dysphagia while eating solid foods (swallowing)
- HEARTBURN: epigastric / retrosternal burning sensation
- Acid regurgitation (water brash), can lead to → chronic cough (especially @ night), asthma, hoarse voice |
✴ Hiatal hernia
- Type 1: sliding h.h. stomach intermittently slides up through the diaphragm (hiatus)
- Type 2: paraoesophagheal h.h. (< common) stomach bulges through hiatus but lies along the esophagus
- Mechanism: muscle weakness or ↑ abdominal pressure |
Acid peptic disease
SECRETION disorder |
Definition:
- Formation of open ulcers in the lining of the stomach, duodenum (upper small intestine), or esophagus
- 1° caused by imbalance between factors that protect the mucosal lining & those that promote its erosion |
Pathophysiology:
- Helicobacter pylori infection: bacterium that colonises in the stomach & weakens the protective mechanisms of the gastric mucosa → > vulnerable to acid & other harmful substances
- Acid production: excessive production (1° hydrochloric acid), contributes to development of peptic ulcers
- Impaired mucosal defence mechanisms: such as reduced mucus production, diminished blood flow to mucosa, or inadequate bicarbonate secretion, can compromise mucosal defense
- NSAIDs: such as aspirin or ibuprofen, can directly irritate gastric mucosa & inhibit the production of protective substances like prostaglandins |
Mechanism: imbalance between aggressive factors (acid & pepsin) & protective mechanisms leads to erosion & damage to the mucosal lining, eventually → formation of ulcers
- Acid: excessive production / secretion of stomach acid ↑ acidity of gastric contents, can damage mucosal lining
- Pepsin: (enzyme that helps breakdown proteins in stomach), when excessive presence, can contribute to mucosal injury
- Mucus secretion: reduced mucus production can make the mucosa more susceptible to injury
- Bicarbonate secretion: (neutralises stomach acid), insufficient secretion can disrupt mucosal defence mechanisms |
Sx & Ssx:
- Epigastric pain: in upper abdomen between meals or during the night
- Heartburn
- Nausea & vomiting: especially if ulcers present in stomach
- Loss of appetite or weight loss
- GI bleeding: in severe cases |
Duodenal cancer is a complication of acid peptic disease
Acute & chronic gastritis
Complication of acid peptic disease |
Definition:
- Sudden onset inflammation in the stomach lining
- Tends affect a wider area of mucosa |
| |
Acute gastritis |
Chronic gastritis |
Pathophysiology & mechanisms: |
- Irritants & toxins: consumption can directly damage the gastric mucosa, leading to acute inflammation
- Helicobacter pylori: infection
- Immune response: immune system triggers an inflammatory response in gastric mucosa, leading to release of inflammatory mediators (lymphocytes & plasma cells), this inflammation can cause damage to mucosal lining |
- Heliobacter pylori: leads to chronic inflammation of the gastric mucosa
- Autoimmune response: mistakenly attacks the stomach lining cells, causing chronic inflammation
- Other factors: prolonged use of NSAIDs, alcohol, bile reflux & certain medical conditions such as Crohn's disease or HIV infection |
Sx & Ssx: |
- Epigastric pain: typically burning or gnawing
- Nausea & vomiting
- Loss of appetite
- Bloating or feeling of fullness
- Hematemesis: in severe cases |
- Dyspepsia: abdominal discomfort after eating (often w/ early satiety & bloating)
- Loss of appetite or weight loss
- Nausea or vomiting
- Bloating or fullness
- Anemia: vitamin B12 deficiency |
Chronic gastritis aka 'atrophic gastritis' is a pre-cancerous condition
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