- •GERD, Gastritis, Peptic
- •Gastro-esophageal reflux disease
- •Heartburn and reflux: what is it?
- •Possible extraesophageal manifestations of GERD
- •Esophageal manometry
- •24-hour monitoring of pH for reflux detection
- •Targets for GERB treatment
- •PPI doses for severe oesophagitis in this guideline update (2014)
- •Balance of aggressive and protective factors in stomac
- •Urease breath test
- •Idiopathic thrombocytopenic purpura
- •COMMON CAUSES OF GASTRITIS
- •COMMON CAUSES OF GASTRITIS
- •Endoscopic findings in gastritis
- •ZES - Zollinger-Ellison Syndrome
- •Diagnosis
- ••The sensitivity of barium radiography for the diagnosis of gastric ulcer is approximately
- •Ulcer at endoscopy.
- •Complications of peptic ulcer
- •Complications of peptic ulcer
- •Gastric cancer
- •ENDOSCOPIC VIEW OF EARLY CANCER
- •ENDOSCOPIC VIEW OF LATE CANCER
- •Treatment
GERD, Gastritis, Peptic
ulcer
Gastro-esophageal reflux disease
Heartburn
(100%)
Epigastric pain
•High risk of complications and low vital quality due to reflux
•Benign origin of pathological signs
Regurgitation
Without
esophagitis
Belching |
Nausea |
With esophagitis |
|
Meteorism |
Abdominal pain |
Symptoms of GERD are not associated with presence of esophagitis
Heartburn and reflux: what is it?
“Burning feeling spreading from |
|
the stomach/lower part of chest to |
Reasons of gastro-esophageal |
the neck” |
reflux |
Dysfunction of esophageal sphincter
Heartburn– most common symptom of
GERD (75%) Slow evacuation
Damage of esophageal clearance
Hernia
Increased intraabdominal pressure
Possible extraesophageal manifestations of GERD
•Bronchial astma
•Sinusitis
•Caries
•Laryngitis
•Ulceration of vocal cords
•Tracheal stenosis
•Laryngospasm
Esophageal manometry
24-hour monitoring of pH for reflux detection
•Degree and duration of reflux
•Compare with symptoms
Targets for GERB treatment
•Relief of symptoms (heartburn)
•Treatment of esophagitis
•Treatment and prevention of complications
Control of acidity – most effective way
• Inhibitors of proton pomp – first line treatment
PPI doses for severe oesophagitis in this guideline update (2014)
Esomeprazole |
40 mg1 once a day |
20 mg1 once a day |
40 mg1 twice a day |
||
Lansoprazole |
30 mg once a day |
15 mg once a day |
30 mg2 |
twice a day |
|
Omeprazole |
40 mg1 once a day) |
20 mg1 once a day) |
40 mg1 |
twice a day |
|
Pantoprazole |
40 mg once a day |
20 mg once a day |
40 mg2 |
twice a day |
|
Rabeprazole |
20 mg once a day |
10 mg once a day |
20 mg2 |
twice a day |
|
1 |
Change from the 2004 dose, specifically for severe oesophagitis, agreed by the GDG during the update of CG17. |
||||
2 |
Off-label dose for GORD. |
|
|
|
|
Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management Clinical guideline [CG184]. NICE guidance
Balance of aggressive and protective factors in stomac
Norm |
Peptic ulcer |