Gastroparesis in gastro esophageal reflux disease - prevalence and assessment using gastric scintigraphy with symptomatic correlation.

Arvind, M A (2013) Gastroparesis in gastro esophageal reflux disease - prevalence and assessment using gastric scintigraphy with symptomatic correlation. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Gastroesophageal Reflux disease (GERD) is a condition that arises from reflux of gastric contents into the esophagus through the lower esophageal sphincter causing symptoms and/or injury to esophageal or extraesophageal structures. While normal people may experience reflux symptoms once in a while, say for example after a heavy meal these are usually infrequent and do not interefere with patients quality of life nor do they cause significant esophageal injury. Pathological reflux occurs when the esophageal defense mechanisms including acid clearance and mucosal resistance are overwhelmed by the injurious refluxate such as acid, pepsin, bile, duodenal contents. Lower Esophageal Sphincter(LES) is the most important component of antireflux barrier and is a tonically contracted smooth muscle of length 3-4cm located at the gastroesophageal junction. Resting LES pressure varies between 10-30 mm Hg and its reserve is high since even a pressure of 5-10mmHg can prevent reflux. Resting tone of LES is a function of both myogenic and neurogenic components. Acetyl choline released from muscarinic system is the predominant neurotransmitter in maintaining resting LES tone. In addition the diaphragmatic contractions augment LES pressure during inspiration. LES is designed naturally to prevent reflux while at the same time it provides air venting through belching mechanism by relaxing transiently, especially postprandially, called as TLOSRs-Transient Lower esophageal Sphincter Relaxations. But, this natural mechanism of belch which when severe and frequent causes pathological reflux. TLOSRs are the predominant cause of GERD in most cases of GERD while in 20% cases LES incompetence is the causative factor. Esophageal syndromes include syndromes which are typically not associated with esophageal injury such as typical reflux syndrome, reflux chest pain syndrome and syndromes associated with esophageal injury such as endoscopic esophagitis, esophageal strictures, barretts metaplasia, adenocarcinoma. extraesophageal syndromes with established associations include reflux cough syndrome, laryngitis, asthma, Dental erosions. AIM : To study the prevalence of gastroparesis in GERD patients and assessment of the same by gastric scintigraphy and correlate it with gastroparesis cardinal symptom index. MATERIALS AND METHODS : The study was conducted at Department of Medical Gastroenterology Rajiv Gandhi Government General Hospital-Chennai and Advanced Nuclear Medicine Research Institute-Chennai from Feb 2012 to Feb 2013 .In all patients history was taken and physical examination done. Then they underwent baseline investigations including complete blood count, fasting and post prandial blood sugar, renal function test, ultrasound abdomen, upper gastrointestinal endoscopy with grading of esophagitis when present, biopsy of lower esophagus was taken if showing severe esophagitis or suspicious for baretts esophagus. Two patients had already undergone 24h ambulatory pH monitoring as part of evaluation outside. GERD was diagnosed by symptomatic criteria – montreal definition(28/28), with the predominant symptoms being heartburn, regurgitation, endoscopic criteria-LA classification (3/28), biopsy criteria (2/28),24hpH criteria /Demeester scoring (2/28). CONCLUSIONS : 1. There is a significant prevalence of gastroparesis in gastroesophageal reflux disease (10.7%). 2. All cases of gastroparesis detected in GERD patients were of mild grade. 3. Fundal retention predominated over antral retention in cases with gastroparesis (66.7% versus 33.3% ). 4. Gastroparesis was found predominantly in female patients (66.7% vs33.3%). 5. The Correlation between gastroparesis Cardinal symptom index and scintigraphic gastroparesis was not significant.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Gastroparesis ; gastro esophageal reflux disease ; prevalence ;gastric scintigraphy ; symptomatic correlation.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:09
Last Modified: 13 Jul 2017 04:09

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