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DISEASES OF THE STOMACH

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Chronic atrophic (type B) Diseases of the Stomach. Symptoms: ... Associated with Atrophic Gastritis. Intestinal Metaplasia. Diffuse Type: Poorly differentiated ... – PowerPoint PPT presentation

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Title: DISEASES OF THE STOMACH


1
DISEASES OF THE STOMACH
  • SUDHIR DUTTA M.D.

2
Diseases of the Stomach
  • 1. Gastritis
  • 2. Gastric Polyps
  • 3. Gastric Ulcers
  • 4. Non-ulcer dyspepsia
  • 5. Gastroparesis
  • 6. Gastric Carcinoma
  • 7. Zollinger-Ellison Syndrome

3
Diseases of the Stomach
  • Symptoms
  • 1. Abdominal Pain (Epigastric)
  • 2. Nausea
  • 3. Vomiting
  • 4. Hematemesis
  • 5. Bloating, Belching, and Dyspepsia
  • 6. Indigestion
  • 7. Progressive weakness and Anemia
  • 8. Misc.

4
Diseases of the Stomach
  • Diagnostic Tests
  • Upper Endoscopy
  • Mucosal Biopsy
  • Upper GI Series
  • Endoscopic Sonography
  • Gastric Motility Studies

5
Diseases of the Stomach
  • Upper Endoscopy

6
Diseases of the Stomach
  • Acute Gastritis
  • Etiology
  • ETOH
  • NSAIDS
  • H. pylori
  • Bile
  • Chronic Gastritis
  • Etiology
  • Chronic (type A)
  • Chronic atrophic (type B)

7
Diseases of the Stomach
  • Symptoms
  • Nausea
  • Indigestion
  • Anemia (Iron/B12 def.)
  • Diagnosis
  • Gastroscopy with Biopsy
  • Therapy
  • Eliminate Gastric Irritant.
  • Ant-Acids
  • Anti-Secretory Drugs
  • Iron Therapy
  • B12 Therapy

8
Diseases of the Stomach
  • Dyspepsia
  • Symptom Complex
  • Epigastric Fullness, Belching/Bloating, Nausea
  • Diagnosis
  • Gastroscopy and Mucosal Biopsy
  • Therapy
  • Acid Suppression, Prokinetic Agents
  • Tegaserod (5HT4 Agonist)
  • Simethicon

9
Diseases of the Stomach
  • Peptic Ulcer Disease
  • Includes gastric ulcer, pyloric channel ulcer,
    and duodenal ulcer.
  • Mucosal damage related to excess acid (HCL) and
    activation of pepsin.
  • Common Causes
  • a) H. pylori
  • b) NSAIDS

10
Diseases of the Stomach
  • Peptic Ulcer Disease
  • Clinical Features
  • Abdominal Pain, dyspepsia, indigestion, GI
    Bleeding, Anemia
  • Diagnosis
  • Endoscopy and Biopsy
  • Therapy
  • Antisecretory Therapy (H2 RB and PPIs)
  • Stop NSAIDS
  • Eradicate H. pylori

11
Diseases of the Stomach
  • Peptic Ulcer Disease Uncommon Causes
  • Gastric Adeno. CA
  • Stress Ulceration
  • CMV and HSV
  • ZE Syndrome
  • Crohns Disease
  • Metastatic Melanoma
  • Mastocytosis
  • Radiation Therapy
  • Chemotherapy
  • Cocaine Induced

12
Diseases of the Stomach
  • H. pylori Infection
  • Most common cause of PUD
  • Higher prevalence in lower socio-economic areas
  • Mode of Transmission
  • Oral-Oral and/or Fecal-Oral
  • Diagnosis
  • HP Serology
  • HP Antigen (fecal)
  • Mucosal biopsy with special stains and Urease
    test.
  • C13 urea breath test

13
Diseases of the Stomach
  • H. pylori Infection Associated Diseases
  • Antral Gastritis
  • Lymphocytic Gastritis
  • MALT Lymphoma
  • Gastric Adenocarcinoma

14
Diseases of the Stomach
  • H. pylori Infection Therapy
  • All cases with PUD
  • Symptomatic Gastritis
  • Therapy Includes
  • a) PPIs
  • b) 2-3 Antibiotics (chlarithromycin,
    amoxicillin, tetracycline, and metronidazole)
  • c) Bismuth Subsalicylate
  • Eradication Rate 70-80
  • Recurrance Rate 2
  • Antibiotic Resistance

15
Diseases of the Stomach
  • Gastric Polyps
  • Common Types
  • Hyperplastic
  • Adenomatosis
  • Inflammatory
  • GIST
  • Carcinoid
  • Neuroendocrine Tumors

16
Diseases of the Stomach
  • Gastric Polyps Diagnosis
  • Endoscopy and Biopsy
  • Therapy
  • Thermal Cautery/Snare Cautery
  • Tyrosine Kinase Inhibitory Antibody for GIST
    Tumors

17
Diseases of the Stomach
  • Gastric Adenocarcinoma
  • Types
  • Intestinal Type
  • Well differentiated
  • Associated with HP infection
  • Associated with Atrophic Gastritis
  • Intestinal Metaplasia
  • Diffuse Type
  • Poorly differentiated
  • Not ass. with HP infection
  • Signet ring cell appearance
  • 3. Prognosis
  • Gastric wall invasion
  • 4. Partial/Total Gastrectomy

18
Diseases of the Stomach
  • Gastroparesis
  • Symptoms
  • Early satiety, nausea, weight loss, post prandial
    bloating, vomiting
  • Diagnosis
  • Gastroscopy
  • Gastric emptying study
  • Causes
  • Diabetes Mellitus, Vagotomy, Scleroderma,
    Amyloidosis, Hypothryoidism, idiopathic

19
Diseases of the Stomach
  • Gastroparesis Therapy
  • Prokinetic agents
  • Erythromycin
  • Tegaserod (5HT4 AG)
  • Gastric Pacemaker
  • Jejunostomy for feeding
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