Assignment: Tx for esophagitis and hiatal hernia and gastropathy

 

Esophagitis Treatment:

Esophagitis- Pill induces

• Instruct patients to take pills with 4 oz water and to remain upright for 30 minutes after ingestion
• Known offending agents should not be given to patients with esophageal dysmotility, dysphagia, or strictures

Candidal esophagitis

• Systemic therapy required for suspected (empiric treatment) or proven esophageal candidiasis: fluconazole, 400 mg on day 1, then 200–400 mg/day orally for 14–21 days

CMV esophagitis

• For initial therapy Ganciclovir, 5 mg/kg every 12 hours intravenously for 3–6 weeks
• After symptoms resolve, convert to valganciclovir, 900 mg once daily orally

Herpetic [HSV] esophagitis

For patients with a normal immune system: symptomatic treatment

• For immunocompromised patients
• Acyclovir, 400 mg five times daily orally, or 250 mg/m2 every 8–12 hours intravenously, usually for 14–21 days

Eosinophilic Esophagitis Treatment

• Remove foods that leads to allergic response
• Inhaled topical corticosteroids without spacer

 

Corrosive Esophagitis

• Supportive treatment: pain medication, IV fluids

 

Treatment for hiatal hernia

Surgical repair is indicated in symptomatic patients. The usual method is to return the herniated stomach below the diaphragm into the abdomen, repair the enlarged esophageal hiatus, and then add a fundoplication. In most cases, the operation can be performed laparoscopically. The results of surgical management are excellent in about 90% of patients.

 Gastritis- superficial inflammation/irritation of the stomach mucosa

Gastropathy- mucosal injury without evidence of inflammation

 

Erosive & hemorrhagic “gastritis” (gastropathy)

 

• There are different types
  • Stress Gastritis- most commonly seen in critically ill patient
    • continuous infusions of a proton pump inhibitor (esomeprazole or pantoprazole, 80 mg intravenous bolus, followed by 8 mg/h continuous infusion) as well as sucralfate suspension (anacids), 1 g orally every 4 to 6 hours.

• NSAID Gastritis: 

• If possible discontinuation of the agent
• If not then reduce to the lowest effective dose
• administration with meals.
  • If the patient has to continue the NSAIDS treatment the a empiric 2- to 4-week trial of an oral proton pump inhibitor has shown to improve symptom so it’s recommended (omeprazole, rabeprazole, or esomeprazole 20–40 mg/day; lansoprazole or dexlansoprazole, 30 mg/day; pantoprazole, 40 mg/day)

 

• Alcoholic Gastritis
  • Therapy with H₂-receptor antagonists, proton pump inhibitors, or sucralfate for 2–4 weeks often is empirically prescribed.

• Portal Hypertensive Gastropathy
  • propranolol or nadolol reduces the incidence of recurrent acute bleeding by lowering portal pressures

NONEROSIVE, NONSPECIFIC GASTRITIS

• Helicobacter pylori Gastritis
  • Eradication of H pylorimay be achieved with antibiotics
  • Most common regime is Clarithromycin, amoxicillin and PPI, however there are other combinations
• Pernicious Anemia Gastritis
  • B-12 injections
  • acid suppression, PPI, H2 blocker, antacids or Sucralfate

Specific types of Gastritis

• Eosinophilic Gastritis
  • Treatment with corticosteroids is beneficial in the majority of patients.
• Infections- treat causative agent meaning, bacteria, fungal or the cause of injection infection
• Ménétrier Disease (Hypertrophic Gastropathy)- acid suppression, PPI, H2 blocker, antacids or Sucralfate

 

Sources:

1. Pance Prep Pearls
2. Quick Medical Diagnosis & Treatment 2020
3. Current Medical Diagnosis and Treatment 2020