University:
Stanford University
Course:
MED 101 | Human Anatomy
Academic year:

2023
Views:

441

Pages:

2
Author:

larbi43100

‭Atypical shapes‬ ‭They can wrongly suggest a non- gastroenterological‬ ‭pathology:‬ ‭ ardiac manifestations: picture of pseudo-anginous chest pain‬ c ‭evoking‬ ‭myocardial ischemia; bradycardia in children; pulmonary manifestations:‬ ‭-‬ ‭asthma, chronic persistent cough, pulmonary fibrosis, pneumonia,‬ ‭chronic bronchitis; demonstrations‬ ‭-‬ ‭-‬ ‭ torhinolaryngological: pharyngeal paresthesias, dysphonia,‬ o ‭pharyngitis, otitis, sinusitis, laryngeal cancer;‬ ‭-‬ ‭other manifestations: dental erosions, sleep apnea.‬ ‭The main complication of gastroesophageal reflux is peptic esophagitis,‬ ‭the relationship of which with‬ ‭Esophageal adenocarcinoma is well documented: in 2010 in the United States,‬ ‭approximately 8,000 esophageal adenocarcinomas were diagnosed,‬ ‭representing approximately half of all types of esophageal cancer.‬ ‭ his esophagitis reflects the effect of gastric contents (hydrochloric acid, pepsin,‬ T ‭bile) on a mucous membrane not protected against these substances. The lesions‬ ‭are of variable importance (erosion, ulceration,‬‭stenosis‬‭) and can lead to the‬ ‭transformation of the epithelium of the lower esophagus into glandular epithelium‬ ‭which will be likely to ulcerate (Barrett's ulcer) and evolve into a‬‭dysplasia‬‭then‬ ‭a‬‭adenocarcinoma‬‭of the esophagus (risk of 0.5% per year, and particularly obese‬ ‭white men in their sixt decade). Barrett's ulcer can be short segment (less than 3‬ ‭cm) or long segment (more than 3 cm): in the latter case, the risk of malignant‬ ‭tumor transformation is very high (30 to 100 times the risk of the general‬ ‭population). Frequent symptoms of reflux lasting at least 10 years justify the‬ ‭performance of a control endoscopy.‬ ‭Hygiene and dietetic measures‬‭-They must always be implemented as a first‬ ‭intention:‬ r‭ aise the head of the bed (4 to 6 inches);‬ ‭-‬ ‭avoid late meals (3 hours before bedtime, as gastric emptying is known‬ ‭to be slowed in these patients); avoid foods that reduce the tone of the‬ -‭ ‬ ‭lower esophageal sphincter or are likely to exacerbate local‬ ‭inflammation (fats, chocolate, alcohol, mint, coffee, citrus juice,‬ ‭tomatoes) as well as, whenever possible , medications that have the‬ ‭same effect (calcium blockers, anticholinergics, progesterone, nitrates).‬ ‭-‬ ‭-‬ ‭avoid ingestion of large quantities of liquid during meals;‬ s‭ top smoking (passive smoking can also lead to gastroesophageal reflux‬ ‭in children);‬ ‭-‬ ‭lose weight if necessary.‬ ‭-‬ ‭Medical treatment‬‭-It may use mucosal protectants (sucralphate),‬ ‭prokinetics (metochlopramide, domperidone), H receptor antagonists‬‭2‬ ‭(cimetidine, ranitidine, nizatidine, famotidine) or proton pump inhibitors or‬ ‭PPIs (omeprazole, esomeprazole, lansoprazole, pantoprazole). In practice, it‬ ‭is mainly PPIs and H2 blockers that are used.‬ ‭Surgical and endoscopic treatments‬‭-They are of course‬‭reserved for special‬ ‭cases. Laparoscopic Nissen fundoplication (which consists of surrounding the‬ ‭lower esophagus with the large gastric tuberosity) gives satisfactory results in‬ ‭95% of cases. Endoscopic injection of a polymer into the lower esophageal‬ ‭sphincter has also been shown to be effective in patients with uncomplicated‬ ‭reflux.‬