Gastric Disorders

Gastritis:

Gastritis is acute or chronic inflammation of the stomach and is most often diffuse. It is usually diagnosed on upper gastrointestinal (UGI) endoscopy and can be confirmed and classified histologically by performing a gastric biopsy.

Acute gastritis:

This is also called or hemorrhagic gastritis. The common causes of acute gastritis are Aspirin and other NSAIDs, Alcohol, Other drugs – iron, potassium chloride, Severe trauma, Significant underlying diseases (sepsis, pulmonary or renal insufficiency), Burns (“Cushing’s ulcer”), CNS trauma (“Curling ulcer”), Bile reflux, Acute H. pylori infection.

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Gastro-Esophageal Reflux Disease:

Gastro-esophageal reflux (GOR) is defined as backward flow of gastric contents into the oesophagus. A small amount of GOR occurs in normal individuals; the term GORD (gastro-esophageal reflux disease) includes all the symptoms and forms of tissue damage secondary to the reflux of gastric contents into the oesophagus. GORD is the most common esophageal disorder, accounting for nearly 75% of all patients with esophageal disorders.

Heartburn and regurgitation are considered typical symptoms and may be the only symptoms in most cases. Other symptoms include dysphagia, chest pain, waterbrash, globus sensation and. Over half the cases of noncardiac chest pain may be attributed to abnormal reflux.

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Peptic Ulcer:

Peptic ulcer is ulceration of the mucosa coming in contact with acid and pepsin. The most common location of peptic ulcers is the first part of the duodenum; this is followed by gastric, lower esophageal and anastomotic jejunal ulcers after gastrojejunostomy.

The highest prevalence of peptic ulcer in India is in Kerala and Tamil Nadu. In India duodenal ulcers are far more common than gastric ulcers (8:1 to 20:1); in the Western countries, the ratio is approximately 4:1.

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Constipation:

Chronic constipation is defined as the presence of two or more of the following symptoms for at least 3 months:

  1. Decrease in frequency of defaecation ( 2 bowel movements per week)
  2. Passage of hard stools more than 25% of the time
  3. Straining at stools more than 25% of the time
  4. Incomplete evacuation more than 25% of the time

The normal stool frequency in Indians is 1 per day, as compared to 3 per week for Western men.

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Haemorrhoids:

Haemorrhoids are masses of vascular tissue in the anal canal. Internal haemorrhoids arise from the superior (internal) haemorrhoidal vascular plexuses, above the pectinate line; they are covered by mucosa. External haemorrhoids are dilatations of the inferior (external) haemorrhoidal plexuses; they lie below the pectinate (dentate) line and are covered by anoderm and perinanal skin. Because the two plexuses anastomose freely, many patients have a combination of both types.

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Fissure-In-Ano (Anal Fissure):

Fissures are most common in young and middle-aged adults. Most of them (>90%) occur in the posterior midline because this area is relatively deficient in blood flow owing to high resting anal pressure; the remainder are in the anterior midline. Fissures in other positions suggest underlying diseases such as Crohn’s disease. Chronic fissure has a characteristic triad: the fissure itself, a hypertrophic anal papilla at the upper end of the fissure, and a sentinel pile or tag at the lower end of the fissure at the anal verge.

Anorectal Abscess:

Anorectal abscesses are infections of the tissue spaces in and adjacent to the anorectum. Patients with Crohn’s disease, haematological disorders or other immunodeficiency states are susceptible.

Anorectal Fistulas:

An anorectal fistula (fistula-in-ano) is a hollow fibrous tract lined by granulation tissue. It has an opening (primary or internal) inside the anal canal or rectum and one or more orifices (secondary or external) in the perianal skin. An anorectal sinus is similar but is blind at one end. Fistulas may also develop due to trauma, fissures, Crohn’s disease and chlamydial infections. Anoscopy reveals the primary opening usually in a crypt and a hooked probe can be inserted to confirm it. The relationship of the fistula to the anorectal ring is of importance in management, and is best evaluated in the conscious patient. Proctosigmoidoscopy must be done routinely.

Irritable Bowel Syndrome (IBS):

Patients with IBS report with abdominal pain and altered bowel habit.

About 15% of the general population have symptoms that justify a diagnosis of IBS; however, only about 20% of these will seek medical opinion, prompting a suggestion of hypersensitivity in them. IBS is the most common single reason for referral to gastroenterologists. In Western series, female patients predominate; in India, most reporting patients are young men, probably only because of social inhibitions in women.

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Ulcerative Colitis:

Ulcerative colitis is a disease of unknown cause. It invariably involves the rectum and extends proximally to involve variable extents of the colon. In 20% of cases the entire colon is involved (universal or pancolitis), 30%-40% of cases have disease beyond the sigmoid colon (left sided colitis) and 40%-50% of cases have disease limited to the rectum and sigmoid (proctosigmoiditis).

The disorder occurs worldwide and usually affects young persons in the age group 20-40 years. The risk of developing the disease is increased 10-fold in family members. There is increased disease concordance in monozygotic twins.