Chapter 39: Management of Esophageal Disorders

Characterized by an incompetent lower esophageal sphincter, pyloric stenosis, hiatal hernia, and motility disorders.
Can lead to Barrett’s esophagus, a condition caused by chronic acid exposure.
Symptoms include pyrosis (heartburn), dyspepsia, regurgitation, dysphagia (difficulty swallowing), odynophagia (painful swallowing), hypersalivation, and esophagitis.
Protective mechanisms against reflux: gravity (upright position), swallowing (clears refluxed liquid), and bicarbonate in saliva neutralizing acid.
Increased risk factors: pregnancy (hormonal changes), weakened esophageal muscles, and mixed connective tissue diseases like scleroderma.
Diagnostic methods include endoscopy, barium swallow, and ambulatory pH monitoring.
Management involves self-care strategies: elevating head of bed (HOB), dietary modifications, and weight loss.
Medications include antacids, H2 blockers, PPIs, and medications like baclofen and sucralfate.
Complications may involve throat and laryngeal inflammation, cough, asthma, lung infections, esophagitis, strictures, and Barrett's esophagus.

Defined as an erosion of the mucous membrane, most commonly located in the duodenum rather than the stomach.
Frequently associated with H. pylori infection, excessive stomach acid secretion, chronic NSAID use, dietary factors, smoking, and genetic predisposition.
Symptoms typically include dull, gnawing pain in the mid-epigastric area, heartburn, and vomiting.
Those aged 40 to 60 are at higher risk, with an increased incidence in postmenopausal women.
Gastric ulcers usually occur in the lesser curvature and can stem from retrograde HCl flow (related to GERD).

A gram-negative rod commonly inhabiting the stomach's antrum, linked to PUD and stomach cancer.
Approximately 50% of the global population is affected, with the highest prevalence in developing countries.
Asymptomatic in around 80% of cases.
Transmission occurs via oral routes, including contaminated food, water, and close contact.

Duodenal ulcers involve excessive gastric acid production and decreased mucosal resistance leading to erosion.
Gastric ulcers show normal or reduced stomach acidity but reduced resistance to bacterial infections like H. pylori.

Symptoms vary, appearing intermittently over days to months.
Chief complaint often includes a burning sensation in the mid-epigastric region, with pain timing differing by ulcer type—immediate after eating for gastric ulcers and 2-3 hours later for duodenal ulcers.
Accompanying symptoms can include sharp tenderness, heartburn, relief from vomiting, changes in bowel habits, and possible gastrointestinal bleeding.

Physical examination and diagnostic procedures include endoscopy as the preferred method and histologic/serologic tests for H. pylori detection.
Ongoing management strategies involve pharmacological approaches and potential lifestyle modifications.