GiT Updates and More

Stages of cirrhosis and advanced chronic liver disease

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.

The American Foregut Society (AFS) grading system for hiatal hernias

Jan.2025 AASLD : SCREENING FOR DEPRESSION AND/OR ANXIETY in cirrhotic patients

Management of Prolonged INR (warfarin-induced coagulopathy)

Summary of Recommendations 🆕 ASGE guidelines on the diagnosis and management of GERD. Dec.2024