Clinical Manifestation and Management of Extra-Esophageal Gastroesophageal Reflux Disease

GERD is a condition that gastric content go back into the esophagus. This condition could came disturbances in the respiratory tract, heart and otolaryng. Those extra-esophageal clinical manifestation are common but often miss our attention. So it is important to explorate it further. The management of extra-esophageal GERD is similar with management of GERD. It is included life style modification and reducing refluxate with controlling pH with aggressiveness

The Diagnostic and Management of Drug Induced Esophagitis

There are several factors that involve in drug induced esophagitis such as: drugs, esophagus, patients. The drug can cause direct effect to the esophageal mucosa. The drugs that often cause esphagitis: alendronate, tetracycline and its derivates and anti retroviral agents. Most of these drugs can cause esophageal damage due to corrosive nature of the drug. Esophageal factor that can cause the drug induced esophagitis: rheumatic heart disease, enlargement of the left atrium mass and aortal aneorysma. These conditions will disturb drug passage and prolongs drug contact with esophageal mucosa. The patients factor that influences this problem is the patients position when taking the drug, the patients age, the amount of water taken along with the drug, the time when drug was taken, and the amount of saliva. Endoscopy is a good procedure to evaluate the esophageal mucosa and establishing differential diagnosis through direct inspection, biopsy. In the management of esophagitis, PPIs are currently the most effectiveness agents available for treating esophagitis. Esomeprazole, an optical isomer of omeprazole is the first PPI to show greater efficacy than other PPI is in esophagitis healing

Polypectomy of Esophageal Polyp Due to Esophagitis

Esophageal polyp can be found by chance during endoscopic examination. Polyps can be formed by changes in the esophageal mucosa due to reflux esophagitis. We report a case of multiple esophageal polyp in a patient with complaints of recurrent regurgitation without heartburn. Endoscopy demonstrated multiple polyps at the distal esophagus. Anatomic pathology evaluation of the polyp demonstrated mucosa lined with squamous epithels demonstrating elongation of the papilla and deposition of acute and chronic inflammatory cells, indicating chronic esophagitis with hyperplastic epithels. In this case, we conducted recurrent ligation of the multiple polyps. Evaluation at 2 weeks after the final ligation demonstrated no polyp remains, and the post-ligation ulcer was found. Evaluation at 1 month following treatment found diminished complaints. From this case, we can conclude that endoscopy is an important investigation modality to establish the diagnosis in cases of chronic gastrointestinal complaints. Ligation is a choice for the management of esophageal polyps

The Relationship Between Gastric Mucosa Mucous Thickness and Gastroscopic Findings in Patients Receiving Non-Steroidal Anti-Inflammatory Drugs

Non-steroid anti-inflammatory drugs (NSAID) can cause gastropathy and gastric mucosa, especially the mucous may play an important prevention role. This cross-sectional, single group study was conducted to know the difference in mucous thickness in antrum or corpus mucosa and the correlation of gastric mucous thickness to gastropathy. Patients who received NSAID from the rheumatology clinic were studied. Healthy subjects of 14 – 65 years old who never received NSAID were included as normal controls. Piroxicam 20 mg daily was given to the patients for 7 days, then gastroscopy and gastric mucosa biopsy with frozen section were performed. Specimens were stained with haematoxyline eosin and thickness of the mucous layer was measured using ocular micrometer. Thirty-two out of 70 patients participated in the study. All cases had hyperemia on gastroscopy with erosions and ulcer in 32 and 9 cases, respectively. The mean thickness of mucosa in distal antrum, proximal antrum and corpus was 28.5 ± 9, 37.4 ± 13.1 and 43.3 ± 13.1 microns, respectively. There was significant relationship between gastric mucosa mucous thickness with gastroscopic findings. In conclusion, this study confirmed that thickness of gastric mucosa mucous has an important role in preventing NSAID gastropathy and dyspeptic complaints in this kind of patients does not suggest abnormalities of gastric mucosa

Colorectal Polyp Evaluation Management and Its Role in Gastrointestinal Tract Malignancy

Colorectal polyp is one of important factors that have roles in developing Malignancy of lower gastrointestinal tract. Adenomatous polyp is the most common colorectal polyps and it has been known as a lesion precursor for transformation process in developing gastrointestinal Malignancy. Such transformation is known as adenocarcinoma sequence, a long-term process which usually does not elaborate any symptoms and remains asymptomatic. Since most colorectal polyps are asymptomatic, they are usually undiscovered at the time of diagnosis and results to the increasing case of Malignancy especially the colorectal cancer. Considering that colorectal cancer still becomes one of the most common causes of death and morbidity worldwide, early detection and elimination of colorectal polyp may have a significant role in preventing lower gastrointestinal tract Malignancy

Specific Subjective Symptoms for Gastroesophageal Reflux Disease in Ulcer Like Dyspepsia

Background: The Aim of study is to identify specific subjective symptoms for gastroesophageal reflux disease (GERD), GERD proportion in ulcer like dyspepsia and the correlation between specific subjective symptoms for GERD and endoscopic examination Result in ulcer like dyspepsia Methods: A cross-sectional study was conducted in 67 patients with ulcer like dyspepsia. The patient's history of illness was taken, and physical and endoscopic examinations were performed. A questionnaire on dyspepsia symptoms was completed. Data analysis was performed to identify the correlation between subjective symptoms and endoscopic examination results using chi-square test. T test was performed to determine the correlation between dyspepsia scores and endoscopic results. Result: Subjective symptoms that correlated with endoscopic results were severe epigastric pain (p=0.080) and the absence of bloating (p=0.055). Dyspepsia scores did not correlate with endoscopic examination results (p=0.725). Conclusion: Specific subjective symptoms for GERD in clinical dyspepsia-like ulcer were severe epigastric pain and absence of bloating. The proportion of such symptoms in ulcer like dyspepsia could assist clinical diagnosis of GERD

Clinical Profile and Outcome of Non-Variceal Upper Gastrointestinal Bleeding in Relation to Timing of Endoscopic Procedure in Patients Undergoing Elective Endoscopy

Background: Endoscopy is the most accurate method for diagnosing the source of upper gastrointestinal bleeding. This study was aimed to evaluate the correlation between the timing of elective endoscopy and the length of hospital stay, the amount of transfusion given and incidence of recurrent bleeding or patient mortality. Method: A retrospective study was conducted in all patients with non-variceal upper gastrointestinal bleeding who had experienced elective endoscopy at Cipto Mangunkusumo Hospital between January 2007 and August 2008. Identification of clinical risk using clinical Rockall score was performed at the emergency room. Persistent bleeding, recurrent bleeding, surgical treatment and death were the outcome variables. Statistical analysis was performed using Chi-square/fisher exact test and linear regression. Results: There were 40 eligible cases with mean age of 53 ± 13 years; the greatest occurrence was at the age group of 50-59 years (12%), male (52.5%) and those who had clinical symptom of melena (52.5%). Twenty seven (67.5%) patients had Rockall score of 1-3 points and 13 (32.5%) had 4-6 points. There was only one patient who had adherent clots (Forrest grade II B). Endoscopy results revealed that the most common cause of bleeding was gastric ulcer, which occurred in 12 (30%) patients. There was no correlation between the timing of endoscopic procedures and outcome variable; however the length of hospital stay had a significant correlation with timing of endoscopic procedures. Conclusion: Elective endoscopy does not affect the variables of mortality and recurrent bleeding; however, it affects the length of hospital stay. Further prospective studies are required to find causal relation between them