clinical method & therapeutics
- 1. Diseases of mouth BY Dr.Laraib Jamil Rph
- 2. Cold sore • Definition: an inflamed blister in or near the mouth, caused by infection with the herpes simplex virus. • Synonym: fever blisters — are a common viral infection. They are tiny, fluid-filled blisters on and around your lips. These blisters are often grouped together in patches. After the blisters break, a crust forms over the resulting sore. Cold sores usually heal in two to four weeks without leaving a scar.
- 4. • Spread of disease: from person to person by close oral contact , Shared eating utensils, razors and towels. • Pathogenesis: They're caused by a herpes simplex virus (HSV-1) closely related to the one that causes genital herpes (HSV-2). Both of these viruses can affect your mouth or genitals and can be spread. • There's no cure for HSV infection, and the blisters may return. Antiviral medications can help cold sores heal more quickly and may reduce how often they return.
- 5. • Symptoms: it passes through different stages • Tingling and itching. Many people feel an itching, burning or tingling)pins & needles) sensation around their lips for a day or so before a small, hard, painful spot appears and blisters erupt. • Blisters. Small fluid-filled blisters typically break out along the border where the outside edge of the lips meets the skin of the face. Cold sores can also occur around the nose or on the cheeks. • Oozing and crusting. The small blisters may merge and then burst, leaving shallow open sores that will ooze fluid and then crust over.
- 6. Some other symptoms are • Fever • Painful eroded(corrosion) gums • Sore throat • Headache • Muscle aches • Swollen lymph nodes
- 7. • Risk factors: About 90 percent of adults worldwide — even those who've never had symptoms of an infection — test positive for evidence of the virus that causes cold sores. • People who have weakened immune systems are at higher risk of complications from the virus. Some other Medical conditions include • HIV, Eczema, skin burns, cancer chemotherapy, anti rejection drugs (in organ transplantation).
- 8. • Complications: • fingertips. Both HSV-1 and HSV-2 can be spread to the fingers. This type of infection is often referred to as herpes whitlow. Children who suck their thumbs may transfer the infection from their mouths to their thumbs. • Eyes. The virus can sometimes cause eye infection. Repeated infections can cause scarring and injury, which may lead to vision problems or blindness. • Widespread areas of skin. People who have a skin condition called eczema are at higher risk of cold sores spreading all across their bodies. This can become a medical emergency. • Other organs. In people with weakened immune systems, the virus can also affect organs such as the spinal cord and brain.
- 9. Diagnosis: • doctor can usually diagnose cold sores just by looking at them. To confirm the diagnosis, he or she may take a sample from the blister for testing in a laboratory.
- 10. • Preventions: • Avoid skin-to-skin contact with others while blisters are present. The virus spreads most easily when there are moist secretions from the blisters. • Avoid sharing items. Utensils, towels, lip balm and other items can spread the virus when blisters are present. • Keep your hands clean. When you have a cold sore, wash your hands carefully before touching yourself and other people, especially babies
- 11. Treatment: • try some cold sore remedies. Some over-the- counter preparations contain a drying agent, such as alcohol, that may speed healing. • Use lip balms and cream. Protect your lips from the sun with a zinc oxide cream or lip balm with sunblock. • Apply a cool compress. • Apply pain-relieving creams.
- 12. 2- Oral thrush • Definition: it is yeast/fungal infection of Candida species on the mucous membranes of the mouth. • Synonym: Oral candidiasis • is a condition in which the fungus Candida albicans accumulates on the lining of your mouth. Candida is a normal organism in your mouth, but sometimes it can overgrow and cause symptoms. • Appearance: Oral thrush causes creamy white lesions, usually on your tongue or inner cheeks. Sometimes oral thrush may spread to the roof of your mouth, your gums or tonsils, or the back of your throat.
- 13. OT • Susceptibility: Although oral thrush can affect anyone, it's more likely to occur in babies and older adults because they have reduced immunity, in other people with suppressed immune systems.
- 15. OT Symptoms: • Creamy white lesions on your tongue, inner cheeks, and sometimes on the roof of your mouth, gums and tonsils • Slightly raised lesions with a cottage cheese-like appearance • Redness, burning or soreness that may be severe enough to cause difficulty eating or swallowing • Slight bleeding if the lesions are rubbed or scraped • Cracking and redness at the corners of your mouth • A cottony feeling in your mouth • Loss of taste • Redness, irritation and pain under dentures (denture stomatitis) • In severe cases (Candida esophagitis)
- 16. OT Pathogenesis: • it is most commonly caused by the fungus Candida albicans, but may also be caused by Candida glabrata or Candida tropicalis. • weakened immune system. Risk factors: • Diabetes. If you have untreated diabetes or the disease isn't well- controlled, your saliva may contain large amounts of sugar, which encourages the growth of candida. • Medications. Drugs such as prednisone, inhaled corticosteroids, or antibiotics that disturb the natural balance of microorganisms in your body can increase your risk of oral thrush. • Other oral conditions. Wearing dentures, especially upper dentures, or having conditions that cause dry mouth can increase the risk of oral thrush.
- 17. OT Preventions: • Rinse your mouth. If you need to use a corticosteroid inhaler, be sure to rinse your mouth with water or brush your teeth after taking your medication. • Brush your teeth at least twice a day and floss daily or as often as your dentist recommends. • Check your dentures. Remove your dentures at night. Make sure dentures fit properly and don't cause irritation. Clean your dentures daily. Ask your dentist for the best way to clean your type of dentures. • See your dentist regularly, especially if you have diabetes or wear dentures. Ask your dentist how often you need to be seen. • Watch what you eat. Try limiting the amount of sugar-containing foods you eat. These may encourage the growth of candida. • Maintain good blood sugar control if you have diabetes. Well- controlled blood sugar can reduce the amount of sugar in your saliva, discouraging the growth of candida.
- 18. OT Treatment: Doctors will usually prescribe anti- thrush drugs, such as nystatin or miconazole in the form of drops, gel, or lozenges. • Alternatively, the patient may be prescribed a topical oral suspension which is washed around the mouth and then swallowed. • Oral or intravenously administered antifungals may be the choice for patients with weakened immune systems. • If treatment is not working, amphotericin B may be used
- 19. OT Home remedies: Rinse mouth with salt water. • Use a soft toothbrush to avoid scraping the lesions. • Use a new toothbrush every day until the infection has gone. • Eat unsweetened yogurt to restore healthy bacteria levels. • Do not use mouthwashes or sprays.
- 20. Oral Lichen Planus Definition: Lichen planus is a chronic inflammatory disease that affects the mucus membrane. Oral lichen planus may occur on its own or in combination with lichen planus of the skin, nails or genitals.
- 22. Appearance: • Typically, oral lichen planus presents as a white, lace-like pattern on the inner surfaces of the cheeks and tongue. • However, it can appear as white and red patches or as areas of ulceration on the lining of the mouth. • Involvement of the gums with oral lichen planus is known as “desquamative gingivitis”; this causes your gums to become red and shiny.
- 23. OLP Causes: The cause of oral lichen planus is not known in most instances but it is likely to have something to do with the body’s immune system. • Oral lichen planus is not an infection and it is not contagious (cannot be passed from person to person). • Some cases of lichen planus may be linked to chronic hepatitis C virus infection; this association is however uncommon in the UK. • In a minority of cases, lesions which resemble those of lichen planus (oral lichenoid lesions) can be caused by some medicines e.g. some drugs prescribed for high blood pressure and diabetes & anti-malarial drugs.
- 24. OLP • It may also be a reaction to metal, such as dental fillings. • It could be triggered by other mouth problems such as having a rough crown or a habit of biting your cheeks or tongue.
- 25. OLP Symptoms: • A burning or stinging discomfort in the mouth when eating or drinking. • Mild cases may be symptom-free. Spicy foods, citrus fruits and alcohol can be particularly troublesome. • If your gums are affected, they may become tender(PAINFULL) and tooth-brushing can be uncomfortable. • Ulcers (often called erosions) may occur and these are especially painful. • Some patients (about 15%) may also have skin lesions of lichen planus.
- 26. OLP Diagnosis: • diagnosis of oral lichen planus based solely on the appearance of your mouth. • However, it is often necessary to take a small sample (biopsy) from an affected area inside the mouth for microscopic examination. A local anaesthetic injection to ‘numb’ the biopsy site is necessary for this procedure.
- 27. OLP Treatment: Anaesthetic (analgesic) mouthwashes are available if your mouth becomes sore and are particularly helpful if used before meals. Benzydamine mouthwash may be helpful. Topical steroids which can be applied locally to the mouth are helpful for most patients. These are available as mouthwashes, sprays, pastes and small pellets which dissolve in your mouth. If your gums are affected (desquamative gingivitis), it is important that you keep your teeth as clean as possible by regular and effective tooth brushing. If not, a build-up of debris (known as plaque) can make your gum condition worse. Your dentist/dental hygienist will be able to give oral hygiene advice and will arrange for scaling of your teeth as necessary. An antiseptic mouthwash or gel may be recommended to help with your plaque control, particularly at times when your gums are sore Daily hydrogen peroxide mouthwash or occasional chlorhexidine twice per week are examples. If possible avoid a mouthwash containing alcohol
- 28. OLP Preventions: Avoid spicy, acidic or salty foods if these make your mouth sore. Keep your teeth clean by using a soft brush and small interdental brushes. Choose a toothpaste with a mild flavour and free from the foaming agent, sodium lauryl sulphate (SLS). In view of the small risk of cancerous change in oral lichen planus, it is important that you ensure that your mouth is checked on a regular basis by a dentist or oral specialist, so that any early changes can be spotted. It is advisable to stop smoking and reduce your alcohol intake to recommended limits (currently 14 units a week for both men and women) as these are the main risk factors for mouth cancer.
- 29. Canker Sore/Mouth ulcer Definition: Also called aphthous ulcers, are small, shallow lesions that develop on the soft tissues in your mouth or at the base of your gums often make eating and talking uncomfortable. Ulcer: an open sore on an external or internal surface of the body, caused by a break in the skin or mucous membrane which fails to heal.
- 31. CS Note : Canker sore is also known as mouth ulcer. • It have same symptoms, risk factors, type, diagnosis, healing period & treatment as canker sore have.
- 32. CS Types of canker sore: • Simple canker sores. These may appear three or four times a year and last up to a week. They typically occur in people ages 10 to 20. • Complex canker sores. These are less common and occur more often in people who have previously had them.
- 33. CS/Mouth ulcer On the basis of size & shape: 1- Minor canker sores • Minor canker sores are the most common and: • Are usually small • Are oval shaped with a red edge • Heal without scarring in one to two weeks 2- Major canker sores are less common and: • Are larger and deeper than minor canker sores • Are usually round with defined borders, but may have irregular edges when very large • Can be extremely painful • May take up to six weeks to heal and can leave extensive scarring
- 34. CS/Mouth ulcer 3- Herpetiform canker sores • Herpetiform(RESEMBLING TO SYMPTOMES OF HERPES) canker sores are uncommon and usually develop later in life, but they're not caused by herpes virus infection. These canker sores: • Are pinpoint size • Often occur in clusters of 10 to 100 sores, but may merge into one large ulcer • Have irregular edges • Heal without scarring in one to two weeks
- 35. CS Causes: The precise cause of canker sores remains unclear, though researchers suspect that • A minor injury to your mouth from dental work, overzealous brushing, sports mishaps or an accidental cheek bite • Toothpastes and mouth rinses containing sodium lauryl sulfate • Food sensitivities, particularly to chocolate, coffee, strawberries, eggs, nuts, cheese, and spicy or acidic foods • A diet lacking in vitamin B-12, zinc, folate (folic acid) or iron • An allergic response to certain bacteria in your mouth • Helicobacter pylori, the same bacteria that cause peptic ulcers • Hormonal shifts during menstruation • Emotional stress
- 36. CS certain conditions and diseases include Celiac disease (gluten-sensitive enteropathy), is an immune reaction to eating gluten, a protein found in wheat, barley and rye. If you have celiac disease, eating gluten triggers an immune response in your small intestine. Crohn's disease is an inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people. Behcet's disease, a rare disorder that causes inflammation throughout the body, including the mouth. HIV/AIDS, which suppresses the immune system.
- 37. CS Symptoms: • A painful sore or sores inside your mouth -- on the tongue, on the soft palate (the back portion of the roof of your mouth), or inside your cheeks • A tingling or burning sensation before the sores appear • Sores in your mouth that are round, white or gray, with a red edge or border • In severe canker sore attacks, you may also experience: • Fever • Physical sluggishness(INACTIVE) • Swollen lymph nodes.
- 38. CS Vs Cold sore Difference b/w cold sore & canker sore: Although cold sores and canker sores are often confused with each other, they are not the same. Cold sores, also called fever blisters or herpes simplex type 1, are groups of painful, fluid-filled blisters. Unlike canker sores, cold sores are caused by a virus and are extremely contagious. Also, cold sores typically appear outside the mouth -- usually under the nose, around the lips, or under the chin -- while canker sores occur inside the mouth
- 39. CS Treatment: • Mouth rinses If you have several canker sores, your doctor may prescribe a mouth rinse containing the steroid dexamethasone to reduce pain and inflammation or lidocaine to reduce pain. • Topical products Over-the-counter and prescription products (pastes, creams, gels or liquids) may help relieve pain and speed healing if applied to individual sores as soon as they appear. Some products have active ingredients, such as:
- 40. CS • Benzocaine (anesthetic) • Hydrogen peroxide Antiseptic Mouth Sore Rinse) • Oral medications • Oral medications may be used when canker sores are severe or do not respond to topical treatments. These may include: • Medications not intended specifically for canker sore treatment, such as the intestinal ulcer treatment sucralfate used as a coating agent • Oral steroid medications when severe canker sores don't respond to other treatments. But because of serious side effects, they're usually a last resort.
- 41. CS Preventions: • Watch what you eat. Try to avoid foods that seem to irritate your mouth. These may include nuts, chips, pretzels, certain spices, salty foods and acidic fruits, such as pineapple, grapefruit and oranges. Avoid any foods to which you're sensitive or allergic. • Choose healthy foods. To help prevent nutritional deficiencies, eat plenty of fruits, vegetables and whole grains. • Follow good oral hygiene habits. Regular brushing after meals and flossing once a day can keep your mouth clean and free of foods that might trigger a sore. Use a soft brush to help prevent irritation to delicate mouth tissues, and avoid toothpastes and mouth rinses that contain sodium lauryl sulfate. • Protect your mouth. If you have braces or other dental appliances, ask your dentist about orthodontic waxes to cover sharp edges. • Reduce your stress. If your canker sores seem to be related to stress, learn and use stress-reduction techniques, such as meditation and guided imagery.
- 42. Gingivitis Gingivitis: Gingivitis is a common and mild form of gum disease that causes irritation, redness and swelling (inflammation) of your gingiva, the part of your gum around the base of your teeth. Synonym: (periodontal disease) surrounding a tooth.
- 47. Gingivitis Symptoms: • Swollen or puffy gums • Dusky red or dark red gums • Gums that bleed easily when you brush or floss • Bad breath • Receding(away from previous position) gums • Tender gums
- 48. Gingivitis Causes: • Plaque forms on your teeth. Plaque is an invisible, sticky film composed mainly of bacteria that forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Plaque requires daily removal because it re-forms quickly. • Plaque turns into tartar. Plaque that stays on your teeth can harden under your gumline into tartar (calculus), which collects bacteria. Tartar makes plaque more difficult to remove, creates a protective shield for bacteria and causes irritation along the gumline. You need professional dental cleaning to remove tartar. • Gingiva become inflamed (gingivitis). The longer that plaque and tartar remain on your teeth, the more they irritate the gingiva, the part of your gum around the base of your teeth, causing inflammation. In time, your gums become swollen and bleed easily. Tooth decay (dental caries) also may result. If not treated, gingivitis can advance to periodontitis and eventual tooth loss.
- 49. Gingivitis • Hormonal changes including puberty, pregnancy, menopause, and monthly menstruation cause increased sensitivity and inflammation in your gums. Take extra care of your teeth and gums during these physiological changes to prevent gum disease. • Poor nutrition deprives the body of important nutrients and makes it more difficult for the body to fight infection, including gum disease.
- 50. Gingivitis Types: There are two main categories of gingival diseases: • Dental plaque-induced gingival disease: This can be caused by plaque, systemic factors, medications, or malnutrition. (Malnutrition results from a poor diet or a lack of food. It happens when the intake of nutrients or energy is too high, too low, or poorly balanced.Under nutrition can lead to delayed growth or wasting, while a diet that provides too much food, but not necessarily balanced, leads to obesity lack of adequate nourishment • Non-plaque induced gingival lesions: This can be caused by a specific bacterium, virus, or fungus. It might also be caused by genetic factors, systemic conditions (including allergic reactions and certain illnesses), wounds, or reactions to foreign bodies, such as dentures. Sometimes, there is no specific cause.
- 51. Gingivitis Diagnosis: • A dentist or oral hygienist will check for symptoms, such as plaque and tartar in the oral cavity. • Checking for signs of periodontitis may also be recommended. This may be done by X-ray or periodontal probing, using an instrument that measures pocket depths around a tooth.
- 52. Gingivitis Treatment: Plaque and tartar are removed. This is known as scaling. This can be uncomfortable, especially if tartar build-up is extensive, or the gums are very sensitive.
- 53. Oesophagitis • Definition: oesophagitis is an inflammation of (tissues damage of the esophagus), the esophagus - the muscular tube that passes food and drink from the mouth to the stomach. It can result in damage of the esophagus. • In some severe cases, untreated esophagitis can lead to alterations in the structure and function of the esophagus.
- 54. Physiology: The esophagus is a muscular tube connecting the throat (pharynx) with the stomach. The esophagus is about 8 inches long, and is lined by moist pink tissue called mucosa. The esophagus runs behind the windpipe (trachea) and heart, and in front of the spine. Just before entering the stomach, the esophagus passes through the diaphragm. Diaphragm: (separates one cavity from another)
- 55. • Functionally, the esophagus can be divided in 3 areas: 1. the upper esophageal sphincter (UES), 2. the esophageal body 3. the lower esophageal sphincter (LES). The coordinated activity of these 3 areas is essential to ensure propulsion of the alimentary bolus from the pharynx into the stomach. In addition, each sphincter has a key role in controlling reflux from the stomach into the esophagus (LES), and from the esophagus into the pharynx and the airway (UES).
- 56. • The upper esophageal sphincter (UES) is a bundle of muscles at the top of the esophagus. The muscles of the UES are under conscious control, used when breathing, eating, belching(dikar) , and vomiting. They keep food and secretions from going down the windpipe • The lower esophageal sphincter (LES) is a bundle of muscles at the low end of the esophagus, where it meets the stomach. When the LES is closed, it prevents acid and stomach contents from traveling backwards from the stomach. The LES muscles are not under voluntary control
- 57. Epidemiology: Esophagitis affects 2 to 5 percent of people aged 55 years or older. Symptoms: Common signs and symptoms of esophagitis include: • Difficult swallowing • Painful swallowing • Chest pain, particularly behind the breastbone, that occurs with eating • Swallowed food becoming stuck in the esophagus (food impaction) • Heartburn • Acid regurgitation (to throw back) • lack of appetite • nausea and possibly vomiting • cough • mouth sores In infants and young children, particularly those too young to explain their discomfort or pain, signs of esophagitis may include: • Feeding difficulties • Failure to thrive (to grow)
- 58. Causes: Esophagitis is generally categorized by the conditions that cause it. In some cases, more than one factor may be causing esophagitis. 1. Reflux esophagitis A valve-like structure called the lower esophageal sphincter usually keeps the acidic contents of the stomach out of the esophagus. If this valve opens when it shouldn't or doesn't close properly, the contents of the stomach may back up into the esophagus (gastroesophageal reflux). Gastroesophageal reflux disease (GERD) is a condition in which this backflow of acid is a frequent or ongoing problem. A complication of GERD is chronic inflammation and tissue damage in the esophagus.
- 59. 2. Eosinophilic esophagitis • Eosinophils are white blood cells that play a key role in allergic reactions. Eosinophilic esophagitis occurs with a high concentration of these white blood cells in the esophagus, most likely in response to an allergy-causing agent (allergen) or acid reflux or both. • Food allergies: In many cases, this type of esophagitis may be triggered by foods such as milk, eggs, wheat, soy, peanuts, beans, rye and beef. However, conventional allergy testing does not reliably identify these culprit foods. • Non-food allergies: People with eosinophilic esophagitis may have other nonfood allergies. For example, sometimes inhaled allergens, such as pollen, may be the cause.
- 60. 3. Lymphocytic esophagitis (LE) is an uncommon esophageal condition in which there are an increased number of lymphocytes in the lining of the esophagus. LE may be related to eosinophilic esophagitis or to GERD. 4. Drug-induced esophagitis • Several oral medications may cause tissue damage if they remain in contact with the lining of the esophagus for too long. For example, if you swallow a pill with little or no water, the pill itself or residue from the pill may remain in the esophagus. Drugs that have been linked to esophagitis include: • Pain-relieving medications, such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, others) • Antibiotics, such as tetracycline and doxycycline • Potassium chloride, which is used to treat potassium deficiency • Bisphosphonates, including alendronate (Fosamax), a treatment for weak and brittle bones (osteoporosis) • Quinidine, which is used to treat heart problems
- 61. 5. Infectious esophagitis • A bacterial, viral or fungal infection in tissues of the esophagus may cause esophagitis. Infectious esophagitis is relatively rare and occurs most often in people with poor immune system function, such as people with HIV/AIDS or cancer. • A fungus normally present in the mouth called Candida albicans is a common cause of infectious esophagitis.
- 62. Other causes • Other causes of esophagitis include alcohol abuse, radiation therapy, nasogastric tubes, and chemical injury from ingested alkaline or acid solutions. Chemical injury can occur if a child drinks cleaning solutions, or if an adult swallows caustic substances during a suicide attempt.
- 63. Risk factors: • Reflux esophagitis Factors that increase the risk of gastroesophageal reflux disease (GERD) — and therefore are factors in reflux esophagitis — include the following: • Eating immediately before going to bed • Dietary factors such as excess alcohol, caffeine, chocolate and mint-flavored foods • Excessively large and fatty meals • Smoking A number of foods may worsen symptoms of GERD or reflux esophagitis: • Tomato-based foods • Citrus fruits • Caffeine • Alcohol • Spicy foods • Garlic and onions • Chocolate • Mint-flavored foods
- 64. Risk factor for Eosinophilic esophagitis Risk factors for eosinophilic esophagitis, or allergy-related esophagitis, may include: • A history of certain allergic reactions, including allergic rhinitis, asthma and atopic dermatitis. Risk factor for Drug-induced esophagitis Factors that may increase the risk of drug-induced esophagitis are generally related to issues that prevent quick and complete passage of a pill into the stomach. These factors include: • Swallowing a pill with little or no water • Taking drugs while lying down • Taking drugs right before sleep, probably due in part to the production of less saliva and swallowing less during sleep • Older age, possibly because of age-related changes to the muscles of the esophagus or a decreased production of saliva • Large or oddly shaped pills
- 65. Complications • Left untreated, esophagitis can lead to changes in the structure of the esophagus (from glossy to valvet). Possible complications include: • Scarring or narrowing (stricture) of the esophagus • Tearing of the esophagus lining tissue from retching (if food gets stuck) or during endoscopy (due to inflammation) • Barrett's esophagus, characterized by changes to the cells lining the esophagus, increasing your risk of esophageal cancer
- 66. Diagnosis: After asking the patient about their symptoms, their medical history, and carrying out a physical examination, the doctor may order some further diagnostic tests: • Barium X-ray: This provides a well-defined X-rays of the esophagus, which helps the doctor determine whether there is any narrowing or structural alteration in the esophagus. (barium shows an outline of organ) • Endoscopy: A long, thin tube with a small camera at the end is threaded down the patient's throat. By looking at the esophagus and possibly taking a small sample, the physician can determine what caused the inflammation. • Tissue samples: A small amount of tissue may be removed to determine whether the inflammation is caused by an organism, allergy, cancer, or a precancerous change. (biopsy) • Allergy: Some tests may be performed to find out whether the patient is sensitive to one or more allergens. This may involve a skin-prick test, blood test, or elimination diet.
- 67. Treatment: Treatment for Gastroesophagal reflux disease (GERD) • Acid blockers, including H2-blockers and proton pump inhibitors: These are drugs that have a long-lasting effect on reducing gastric acid production. • Fundoplication: This is surgery to treat GERD. Part of the stomach is wrapped around the lower esophageal sphincter, which strengthens it and prevents stomach acid from making its way back to the esophagus.
- 68. Esophagitis • Corticosteroids: These oral medications can reduce allergy-related inflammation, resulting in less inflammation in the esophagus, allowing it to heal. • Inhaled steroids: Primarily used for the treatment of asthma, inhaled steroids can help reduce the symptoms of eosinophilic esophagitis. • Proton pump inhibitors: Patients with esophagitis caused by allergies may have good results when prescribed proton pump inhibitors if there is a certain amount of reflux as well. • Food allergy: The treatment here is simply to eliminate foods that cause allergies. A doctor will usually refer the patient to a qualified dietician, or in some cases to an allergist for testing if it is unclear which foods are related. • Esophagitis caused by certain medications: The doctor may prescribe an alternative medication, or change how it is given - from solid to liquid form, for example. • Esophagitis caused by infections: The doctor will probably prescribe a specific medication to fight the infection, depending on whether the pathogen is a virus, fungus, parasite, or bacterium. • Severe narrowing of the esophagus: A procedure may be performed to dilate the esophagus.
- 69. Some conditions which can lead to esophagitis Gastroesophageal reflux disease (GERD): • When you swallow food or liquid, it automatically passes through the esophagus, which is a hollow, muscular tube that runs from your throat to your stomach. The lower esophageal sphincter, a ring of muscle at the end of the esophagus where it joins the stomach, keeps stomach contents from rising up into the esophagus. • The stomach produces acid in order to digest food, but it is also protected from the acid it produces. With GERD, stomach contents flow backward into the esophagus. This is known as reflux.
- 71. GERD • Symptoms: • People with GERD may experience symptoms such as heartburn, a sour, burning sensation in the back of the throat, chronic cough, laryngitis (larynx=breath control+ protection of trachea+sound production), and nausea.
- 72. Barrett’s Esophagitis It is a serious complication of GERD, In Barrett's esophagus, normal tissue lining the esophagus changes to tissue that resembles the lining of the intestine. About 10% of people with chronic symptoms of GERD develop Barrett's esophagus. Intestinal lining : columnar Barrrett’s linning: inflamed broken lining columnar
- 73. B.E • Symptoms: same like GERD • Diagnosis: Because there are often no specific symptoms associated with Barrett's esophagus, it can only be diagnosed with an upper endoscopy and biopsy • Endoscopy: To perform an endoscopy, a doctor called a gastroenterologist inserts a long flexible tube with a camera attached down the throat into the esophagus after giving the patient a sedative. The process may feel a little uncomfortable, but it isn't painful. Most people have little or no problem with it. • Once the tube is inserted, the doctor can visually inspect the lining of the esophagus. Barrett's esophagus, if it's there, is visible on camera
- 74. B.E • Risk factors: Risk factors include • age over 50, • male sex, • white race, • hiatal hernia, • long standing GERD, • overweight, especially if weight is carried around the middle.
- 75. B.E Treatment: Barrett's esophagus by treating and controlling acid reflux. This is done with lifestyle changes and medication. Lifestyle changes include taking steps such as: • Make changes in your diet. Fatty foods, chocolate, caffeine, spicy foods, and peppermint can aggravate reflux. • Avoid alcohol, caffeinated drinks, and tobacco. • Lose weight. Being overweight increases your risk for reflux. • Sleep with the head of the bed elevated. Sleeping with your head raised may help prevent the acid in your stomach from flowing up into the esophagus. • Don't lie down for 3 hours after eating. • Take all medicines with plenty of water.
- 76. B.E The doctor may also prescribe medications to help. Those medications may include: • Proton pump inhibitors that reduce the production of stomach acid • Antacids to neutralize stomach acid • H2 blockers that lessen the release of stomach acid • Promotility agents -- drugs that speed up the movement of food from the stomach to the intestines
- 77. Some time high grade damage can lead to adrenocarcinoma which can be trearted through • Cryotherapy: which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. The cells are allowed to warm up and then are frozen again. The cycle of freezing and thawing damages the abnormal cells. • Photodynamic therapy: which destroys abnormal cells by making them sensitive to light. • Surgery in which the damaged part of your esophagus is removed, and the remaining portion is attached to your stomach
- 78. • Types of esophagitis: • Reflux esophagitis (GERD) • Barrett’s esophagitis • Eosinophilic esophagitis
- 79. E.E Eosinophilic esophagitis: • In eosinophilic esophagitis , a type of white blood cell (eosinophil) builds up in the lining of the tube that connects your mouth to your stomach (esophagus). This buildup, which is a reaction to foods, allergens or acid reflux, can inflame or injure the esophageal tissue. Damaged esophageal tissue can lead to difficulty swallowing or cause food to get stuck when you swallow.
- 80. E.E Mechanism: • Eosinophilic esophagitis: eosinophils are a normal type of white blood cells present in your digestive tract. However, in eosinophilic esophagitis, you have an allergic reaction to an outside substance. The reaction may occur as follows: • Reaction of the esophagus. The lining of your esophagus reacts to allergens, such as food or pollen. • Multiplication of eosinophils. The eosinophils multiply in your esophagus and produce a protein that causes inflammation. • Damage to esophagus. Inflammation can lead to scarring, narrowing and formation of excessive fibrous tissue in the lining of your esophagus. • Dysphagia and impaction. You may have difficulty swallowing (dysphagia) or have food become stuck when you swallow (impaction).
- 81. E.E Symptoms: • Difficulty swallowing (dysphagia) • Food getting stuck in the esophagus after swallowing (impaction) • Chest pain that is often centrally located and does not respond to antacids • Persistent heartburn • Upper abdominal pain • No response to gastroesophageal reflux disease (GERD) medication • Backflow of undigested food (regurgitation)
- 82. E.E Diagnosis: • Eosinophilic Esophagitis and Allergies The majority of patients with EoE are atopic. An atopic person is someone who has a family history of allergies or asthma and symptoms of one or more allergic disorders. These include asthma, allergic rhinitis, atopic dermatitis (eczema) and food allergy. EoE has also been shown to occur in other family members.
- 83. E.E • Eosinophilic Esophagitis: Prick Skin Testing Prick skin testing introduces a small amount of allergen into the skin by making a small puncture with a prick device that has a drop of allergen. Foods used in allergy testing sometimes come from commercial companies. Occasionally foods for skin prick testing are prepared fresh in the allergist’s office or supplied by the family. Allergy skin testing provides the allergist with specific information on what you are and are not allergic to. Patients with allergies have an allergic antibody called Immunoglobulin E (IgE). Patients with IgE for the particular allergen put in their skin will have an area of swelling and redness where the skin prick test was done. It takes about 15 minutes for you to see what happens from the test. However, these tests may have limited use in identifying foods causing or driving EoE.
- 84. E.E Eosinophilic Esophagitis: Food Patch Tests . Food patch testing is another type of allergy test that can be useful in diagnosing EoE in some patients. • This test is used to determine if the patient has delayed reactions to a food. • The patch test is done by placing a small amount of a fresh food in a small aluminum chamber called a Finn chamber. The Finn chamber is then taped on the person’s back. The food in the chamber stays in contact with the skin for 48 hours. It is then removed and the allergist reads the results at 72 hours. Areas of skin that came in contact with the food and have become inflamed may point to a positive delayed reaction to the food. • The results from the food patch test may help your doctor see if there are foods you should avoid.
- 85. E.E Treatment: • Remove allergic diet • Corticosteroids to remove inflammation • PPI to reduce acidity problems • Remaining other treatment is same.