Oral Manifestations of GI Pathology PDF

Oral Manifestations of GI Pathology Gastroesophageal Reflux (GERD) Reflux of stomach acid back to esophagus o Of concern when occurring chronically Second most common GI disorder (IBD- 1st most common) o More prevalent in Western countries (North America) o Incidence of GERD is 5 per 1000 people in...

Oral Manifestations of GI Pathology Gastroesophageal Reflux (GERD) Reflux of stomach acid back to esophagus o Of concern when occurring chronically Second most common GI disorder (IBD- 1st most common) o More prevalent in Western countries (North America) o Incidence of GERD is 5 per 1000 people in the US adult population Causes of GERD: o Low LES Tone § Prolonged Relaxation (Less tone, high pressure) § Regurgitation of gastric contents into the esophagus § Esophagitis leading to lining damage § Histological changes to esophageal mucosal cells: metaplasia then dysplasia (sq epithelium à columnar) § High risk of esophageal cancer o Hiatal Hernia § Increases angulation between gastroesophageal junction and gastric fundus Can lead to esophageal § Acidity goes into esophagus b/c part of stomach protrudes into esophagus motility disorder due to § Compromises LES function damaged esophagus o High Intragastric Pressure § High abdominal pressure than resting pressure of the LES o High Acid Secretion § Some cells of the stomach overproduce HCl § Esophageal Motility Disorders: Esophageal inflammation leads to altered contractions which reduces the esophageal motility affecting the esophageal acid clearance § From stress, infection, medication Clinical Manifestations of GERD o Esophageal Manifestations § Heartburn/Neck pain: Burning sensation in chest can also perceive in neck § Regurgitation: When stomach content moves up to mouth Dyspepsia: burning in upper abdomen NOT heart o Extraesophageal Manifestations § Non-Cardiac Chest Pain (NCCP) — Mimics cardiac conditions — Pain in back, neck, jaw, or arms, lasting from min to hr — Rule out cardiac dz via cardiac assessment § Pulmonary Manifestations — Chronic cough (> 8 wks) from irritated tracheal-bronchial tree — Asthma (wheezing, coughing, dyspnea) leading to bronchoconstriction — Activation Vagus neural reflex can restrict airway and cause asthma — Rule out pulmonary disease via radiography and chest x-ray § Otorhinolaryngological Manifestations — Laryngitis: Gastric contents into larynx — Erosive esophagitis: Ulceration — Esophageal strictures: Narrowing of esophagus from inflammation — Barrett’s Esophagus: Metaplasia leads to Dysplasia (Adenocarcinoma) o Oral and Maxillofacial Manifestations § Xerostomia (indirect effects) § Halitosis (direct effects) § Mucositis/stomatitis and aphthous-like ulcerations (direct effects) § Gingivitis and periodontitis (indirect effects) § Oral burning/altered taste (direct effects) § Dental erosion § Bruxism § Temporomandibular disorder (TMD) GERD directly leads to: Halitosis Gerd indirectly leads to: Xerostomia Xerostomia Saliva is the main defense mechanism against acid exposure in the oral cavity o Made of water, proteins, salt o Protection factors: IgA antimicrobial Quantity/Quality of saliva decides ability of neutralization and clearance GERD pts: salivary flow, swallowing function significantly reduced o Reduction of saliva amount leads to oral dryness: xerostomia o Decreased hygiene, digestion, lubrication, taste bud change Halitosis Main Cause: less function of LES facilitating backflow of gastric contents into esophagus leading to foul breath Other Causes: o Acidic contents of stomach reach nasopharynx causing irritation, resulting in postnasal drip o Direct acid-peptic injury to susceptible supraesophageal tissue Mucositis/Stomatitis in Aphthous like Ulceration Mucositis: inf. of mucosal membrane Due to the contact of acid with the oral mucosa Stomatitis: inf. of oral cavity Erythematous mucosa on: Directly leads to GERD o Palate o Uvula o Floor of mouth Direct content of acid leads to aphthous ulcers Most effected: Posterior oral cavity (lateral and ventral tongue, throat) Gingivitis and Periodontitis Inflammation of gingiva and periodontium GERD: Perio > gingivitis o From poor salivary function o Hyposalivation leads to chronic perio and proliferation of bad bacteria Gingivitis Early stage gum dz Periodontitis Progression of gum dz Oral Burning/Altered Taste Burning sensation: Direct contact of oral mucosa w gastric acid Hyperesthesia: exaggerated sensitivity to touch stimuli from reflux-based irritation Tongue burning and dysgeusia due to functional state change of tongue (taste buds) after injury w acid from reflux Dental Erosion Irreversible loss of enamel (NO BACTERIAL INVOLVEMENT) o Hydroxyapatite damaged when pH drops