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Gi doctor with interests in endoscopy, gut health, liver & medicine in general.
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5 332
Natural history and progression of metabolic dysfunction associated steatotic liver disease
Lancet Gastroenterol Hepatol Oct.2024
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Subgrouping of Rome IV irritable bowel syndrome with TREATMENTS suggested according to cluster.
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Causes of REFRACTORY GERD :
🔸 Anatomical Factors
1- Hiatal hernia: Stomach bulging through the diaphragm, impairing lower esophageal sphincter (LES) function.
2- Weak lower esophageal sphincter (LES): Inadequate closure, allowing stomach acid to flow back into the esophagus.
3- Esophageal dysmotility: Abnormal muscle contractions, hindering food passage.
🔸 Lifestyle Factors
1- Obesity: Increased abdominal pressure, exacerbating reflux.
2- Smoking: Weakening LES and reducing saliva production.
3- Alcohol consumption: Relaxing LES and increasing stomach acid.
4- Poor diet: Consuming trigger foods (citrus, chocolate, spicy or fatty foods).
5- Eating habits: Late-night eating, lying down after meals.
🔸Medical Conditions
1- Gastroparesis: Delayed stomach emptying, increasing reflux.
2- Diabetes: Neuropathy affecting LES function.
3- Scleroderma: Fibrosis and muscle weakness.
4- Asthma: Increased coughing, exacerbating reflux.
🔸 Medication-Related
1- PPI non-response: Inadequate acid suppression.
2- PPI intolerance: Side effects or interactions.
3- Other medications: Anticholinergics, sedatives, or calcium channel blockers relaxing LES.
🔸 Other Factors
1- Aging: Decreased LES function and esophageal motility.
2- Genetic predisposition: Family history.
3- Previous surgery: Incomplete or compromised anti-reflux procedures.
🔸 Diagnostic Considerations
1- Upper GI series: Imaging to evaluate anatomy.
2- Endoscopy: Visualizing esophageal mucosa.
3- Ambulatory pH monitoring: Assessing acid reflux.
4- Esophageal manometry: Evaluating LES function and motility.
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Personalisation of therapy in irritable bowel syndrome:
a hypothesis.
Lancet Gastroenterol Hepatol
Dec.2024
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Jan.2025 AASLD : SCREENING FOR DEPRESSION AND/OR ANXIETY in cirrhotic patients
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Jan.2025 AASLD : SCREENING FOR DEPRESSION AND/OR ANXIETY in cirrhotic patients
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Conclusion : Despite its perceived safety, acetaminophen is associated with several serious complications. Given its minimal analgesic effectiveness, acetaminophen as the first-line oral analgesic option for long-term conditions in older people requires careful reconsideration.
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+1
Summary of Recommendations
🆕 ASGE guidelines on the diagnosis and management of GERD. Dec.2024
