HIATAL HERNIA

Definition

 A hiatal hernia occurs when a part of your stomach pushes upward through your

diaphragm.

 Small hiatal hernia may not cause any problem, while a Large hiatal hernia can allow food

and acid back up into your esophagus, leading to Heartburn.

Symptoms

 Small Hiatal Hernia

 No signs or symptoms

 Large Hiatal Hernia

 Heartburn

 Belching

 Difficulty Swallowing

 Chest or Abdominal pain

 Feeling especially full after meals

 Vomiting blood or passing black stools, may indicate Gastrointestinal bleeding

Causes

 Occurs when weakened muscle tissue allows your stomach to bulge up through you

diaphragm.

 Possible causes;

 Injury to the area

 Being born with an unusually large hiatus

  Persistent and intense pressure on the surrounding muscles, such as when coughing,

vomiting or straining during a bowel movement, or while lifting heavy objects.

Risk Factors

 Most common in people who are;

 Age 50 or older

 Obese

Test and Diagnosis

 Often discovered during a test or procedure to determine cause of heartburn or chest or

upper abdominal pain. Such as;

 Blood testing

 An esophagram (barium swallow)

 Endoscopy

 Manometry

ESOPHAGITIS

Definition

 Inflammation that may damage tissues of the esophagus, the muscular tube that delivers

food from the mouth to the stomach.

Symptoms

 Common symptoms include;

  Difficult swallowing

 Painful swallowing

 Chest pain, particularly behind the breastbone that occurs with eating

 Swallowed food becoming stuck in the esophagus (food impaction)

 Heartburn

 Acid regurgitation

 In young children signs may include;

 Feeding difficulties

 Failure to thrive

Causes

 Generally categorized by the conditions that causes it. In some cases, more than one factor

may be the cause of this.

 Reflux esophagitis –a complication of GERD is chronic inflammation and tissue

damage in the esophagus

 Eosinophilic esophagitis – occurs due to a high concentration of eosinophils in the

esophagus, most likely in response to a allergy-causing agent (allergen) or acid

reflux or both

 Drug-induced esophagitis – several oral medications that remains in contact with

the lining of the esophagus for too long may cause tissue damage

 Infectious esophagitis – caused by bacterial or fungal infection in tissues of the

esophagus
Risk Factors

 Vary depending on the different causes of the disorder.

Complications

 If left untreated, esophagitis can lead to changes in the structure of the esophagus. Possible

complications include;

 Narrowing of the esophagus(esophageal stricture)

 Barrett’s esophagus, characterized by changes to the cells lining in the esophagus,

increasing risk of esophageal cancer

Test and Diagnosis

 Barium X-ray

 Endoscopy

 Laboratory tests – biopsy

BENIGN ESOPHAGEAL STRICTURE

Definition

 Narrowing or tightening of the esophagus.

 Typically occurs when stomach acid and other irritants damage the lining of the esophagus

over time. This leads to inflammation (esophagitis) and scar tissue, which causes the

esophagus to narrow.
Symptoms

 Typical symptoms are;

 Difficult or painful swallowing

 Unintended weight loss

 Regurgitation of foods or liquids

 Sensation of something stuck in the chest after you eat

 Frequent burping or hiccups

 Heartburn

Causes

 Can happen when scar tissue forms in the esophagus.

 Most common cause: Gastrointestinal Reflux Disease (GERD)/ acid reflux

 Other cause;

 Frequent exposure to harmful stomach acid

 Radiation therapy to the chest or neck

 Accidental swallowing of an acidic or corrosive substance (batteries or household

cleaners)

 Extended use of nasogastric tube

 Esophageal damage caused by an endoscope

 Treatment of esophageal varices

Complications

 Dense and solid foods can lodge in the esophagus, which may cause choking or difficulty

breathing
  Problem in swallowing can prevent you from getting enough liquid and food which may

lead to dehydration and malnutrition

 Risk of getting pulmonary aspiration

Test and Diagnosis

 Barium swallow test

 Upper GI endoscopy

 Esophageal pH monitoring

Treatment

 Varies depending on the severity and underlying cause

 Esophageal dilation

 Esophageal stent placement

 Change in diet and lifestyle

 Medication

 Surgery

IRRITABLE BOWEL SYNDROME

Definition

 Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine

(colon).

 Needs long term management.

Symptoms

 Most common symptoms:

 Abdominal pain or cramping

 A bloated feeling

 Gas

 Diarrhea or constipation –sometimes alternating bouts of constipation and diarrhea

 Mucus in stool

 Symptoms that may indicate a more serious condition include:

 Rectal bleeding

 Abdominal pain that progresses or occurs at night

 Weight loss

Causes

 Not known, but a variety of factors play a role

 Strong and longer than normal intestinal contractions – gas, bloating, and diarrhea

 Weak and slow intestinal contractions – slow food passage, hard stools, and dry stools

 Abnormalities in the gastrointestinal nervous system

 Poorly coordinated signals between the brain and the intestines – overreaction to changes

in normal digestive process can cause pain, diarrhea or constipation.

 Triggers vary from person to person: Foods, Stress, Hormones, Other illnesses

Risk Factors

 More likely to have IBS are those:

 Young. People under age 45

  Female. About twice as many women as men have the condition

 Family history. Increased risk

 Have a Mental Health Problem. Anxiety, depression, personality disorder and a hx

of childhood of sexual abuse, domestic abuse

Complications

 Diarrhea and constipation, both signs of IBS, can aggravate hemorrhoids.

 Avoidance of certain foods may lead to malnourishment

 Discouragement or depression

Test and Diagnosis

 Rome criteria

 Manning criteria

 Additional tests:

 Flexible sigmoidoscopy

 Colonoscopy

 X-ray (radiography)

 Computerized tomography (CT) scan

 Lower GI series

 Laboratory tests:

 Lactose intolerance test

 Breath test

 Blood test

 Stool test
Treatment

 Treatment focuses of the relief of symptoms

 Dietary changes

 Eliminating high-gas foods

 Eliminating gluten

 Eliminating FODMAPS

Medications

 Fiber supplements

 Anti-diarrheal medications

 Anticholinergic and antispasmodic medications

 Antidepressant medications

 Antibiotics

 Counseling

 Medications especially for IBS:

 Alesetron (Lotronex)

 Lupiprostone (Amitiza)

 Lifestyle and home remedies

 Experiment with fiber

 Avoid problem foods

 Eat at regular times

 Take care with dairy products

 Drink plenty of fluids/liquids

 Exercise regularly

 Use of anti-diarrheal medications and laxatives with CAUTION

 REFERENCES:

 https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/symptoms-

causes/syc-20373379

 https://www.healthline.com/health/esophageal-stricture-benign

 https://www.healthline.com/health/esophagitis

 https://www.mayoclinic.org/diseases-conditions/irritable-bowel-

syndrome/symptoms-causes/syc-20360016