Bloating

Non endoscopicevaluation of GERD, Chest pain and dysphasia.

  • Two types of motility disorders.  Inhibitory innervation disorders (achalasia, DES, transient LES relaxations) and excitatory innervation disorders (hypertensive or hypertensive peristalsis, nutcracker esophagus,)
  • High resolution manometry is faster, easier to perform and better readings.
  • HRM has 36 sensors. 
  • Chicago criteria for abnormalities.
  • 24 hr pH should be done off medicines.
  • Bravo is superior for diagnosing GERD
  • Impedence measurement - when food touches catheter the impedence decreases (electric current is transmitted in the catheter)

Treatment of Dyspepsia

  • FD : functional dyspepsia  :  heartburn, early satiety are 2 of the most common symptoms.
  • FD patients : always related to eating in one way or the other.
  • 65% of patients with UGI symptoms have FD.
  • Differentiate between FD and GERD. A little heartburn does NOT mean reflux disease
  • Alarm symptoms are bleeding, family history, weight loss, persistent vomiting,  etc prompt EGD is needed
  • All NSAIDs cause dyspepsia. (even without ulcers)  Take a detailed medication history.
  • If no alarm symptoms, emperic treatment with PPI and treat Hp. 
  • Epigastric pain syndrome (EPS) and second type of FD is post prandial distress syndrome (PPDS)
  • Treatment options are treatment of Hp, PPI, H2 blockers, prokinetics, antidepressants, antacids, bismuth salts, carafate, herbals.
  • FD pts who are more than 40, GERD symptoms, shorter duration pts respond to PPI.
  • PPDS do NOT respond to PPI but EPS pts do respond.
  • If PPI does not work try H2 blockers
  • Bismuth and carafate work as good as placebo!!
  • Lack of fundic relaxation in FD patients causes early satiety
  • Post infectious FD for eg. Salmonella gastroenteritis
  • Nutrient (ensure) drink test and water load test
  • Reglan does not work and lack of safety.
  • Iberogast STW5 might work.  It does relax the fundus.
  • Antidepressants- use as second or third line for treatment
  • Venlafaxine SSRI may work
  • Eosinophils in duodenum often found in pts with FD.