Aphthous:Idiopathic Pre-menstrual Infection:Fungal e.g. Candidiasis Bacterial e.g. Vincent’s angina, Syphilis Viral e.g. herpes simplexGIT diseases:Crohn’s diseaseCeliac diseaseDermatological conditions:Lichen planus dermatitis herpetiformisPemphigus erythema multiformiPemphegoid
Drugs:Hypersensitivity e.g. Steven’s Johnson syndrome NSAID losartan ACE inhibitor cytotoxicSystemic diseases:SLEBehcet’s disease Neoplasia:Carcinoma Leukemia Kaposi’s Sarcoma
Oral ulceration in patient with aplastic anemia
Aphthous ulcerationDeep ulcers in patient with Behcet Disease
Oral thrushAcute oral candidiasis
Chronic oral candidiasisHerpes Simplex
Angular Stomatitis & atrophic glossitis in patient with IDA
Angular StomatitisStevens Johnson’s syndrome
Lichen planusPeutz Jegher syndrome
ScurvyGingival hypertrophy due to phenytoin therapy
Lead poisoningYellow staining of teeth due to Tetracyclin therapy
Gastro-Esophageal Reflux Disease (GERD): It is a chronic disorder which describes any symptomatic or histopathologic alteration resulting from episodes of gastro-duodenal reflux into the esophagus and/or adjacent organs more than twice/week for more than 2 months
ERD Erosive Reflux Disease 1/3
NERD Non Erosive Reflux Disease 2/3Typical: Heartburn Acid regurgitation > 2x/week > 4 to 8 weeks
Esophageal: Non-cardiac chest pain Non-obstructive dysphagia Globus hystericusPulmonary: Asthma Chronic cough Hemoptysis Bronchitis Bronchiectasis Recurrent pneumonia
Otorhinolaryngological: Hoarseness Throat cleaving laryngitis Sinusitis Otolagia
Oral Etching of dental enamel HalitosisShubbar & Taka
Increasing Prevalence: 1976 15% 1988 44%Transient lower esophageal sphincter (LES) relaxation Hypotensive LES Delayed Esophageal clearance Delayed gastric emptying Salivary function Tissue resistance
Age Alarm features Dysphagia Odynophagia Weight loss GI bleeding Nausea &/or vomiting Family history of cancer Nocturnal reflux
Indications: Age over 40 years-old Alarm features Atypical symptoms
Useful in:Grading Hiatus hernia Ulcer or stenosisBarrett’s Esophagus -ve endoscopy is seen in 2/3 of GERDIndications: Atypical symptoms NERD who do not respond to PPI When esophagitis is not demonstrated in the pre-operative endoscopic examination . IMPEDANCE testing
Symptoms
Antacids/AlginatesProton pump inhibitor Full dose
Poor response
Consider pH Monitoring
Reconsider diagnosis
Normal
Fundoplication
Proton pump inhibitor Maintenance dose
Good response
H2 receptor Antagonists
Antacids
Behavioral modifications in the treatment of GERD
Elevation of the headboard of the bed (15 cm) Ingestion of the following foods in moderation & based on symptom correlation: fatty foods, citrus, coffee, chocolate, alcoholic & carbonated beverages, mint, tomato-based products.