Functional GI disorders include Functional Dyspepsia and Irritable Bowel Syndrome- Dr. Zahid Azam


 World Digestive Health Day Meetings at DUHS, SIUT

Functional GI disorders include
Functional Dyspepsia and Irritable
Bowel Syndrome- Dr. Zahid Azam

DKA, sickle cell crisis, heavy metal poisoning and acute
porphoria are some of the metabolic causes of
abdominal pain - Shahab Abid

KARACHI: Dow University of Health Sciences in collaboration with Pakistan Society of Gastroenterology and G.I.Endoscopy organized a meeting at DUHS Campus on May 29th 2015 to celebrate the World Digestive Health Day. It was jointly chaired by Prof. Saeed Qureshi President PSG & GI Endoscopy, Prof. Abu Talib and Prof. Rauf Memon.

Dr. Zahid Azam consultant gastroenterologist at DIMC was the first speaker who talked about functional GI disorders. These disorders, he said, can be divided into Functional Dyspepsia and Irritable Bowl Syndrome. Presenting complaints by patients with functional dyspepsia are epigastric pain, epigastric burning, early satiation and bothersome postprandial fullness. Diagnosis is by careful history and physical examination based on the symptoms. Endoscopy may be needed to confirm it. In case of mild gastritis there are no gastric erosions. Functional dyspepsia consists of 11-15% of a physician’s practice. Almost 15% of population suffers from IBS and 85% of them do not consult the physician for treatment. Its onset is associated with mild changes in frequency of stool. The patient feels improvement on defecation. There can be changes in the formation of stool. Patients complain of lower abdominal pain, bloating, incomplete evacuation of stool and altered bowl function symptoms. Investigations needed include stool studies, CBC, LFT, TSH, endoscopy and colonoscopy after the age of fifty years. IBS, Dr. Zahid Azam remarked is not a disease but a condition which affects quality of life. Among the differential diagnosis, he mentioned IBD, infections, peptic ulcer disease and chronic pancreatitis etc.

Speaking about the Red Flag in this condition, Dr. Zahid Azam mentioned anemia, fever, rectal bleeding, severe constipation and unexplained weight loss. The patients come with abdominal pain, changes in bowel habits and feeling of discomfort. One must assess the patient and then reassure them that there was noting serious, wrong with them. Most often it is a psychosomatic disorder, he added.

Prof. Shahab Abid from Aga Khan University discussed abdominal pain and pointed out that pain is an objective as well as subjective condition. Elderly and patients with have vague complaints of atypical presentation while immuocompromised patient will also suffer form abdominal pain. It can also be due to DKA, sickle cell disease, heavy metal poisoning and acute porphoria which are some of the metabolic causes of abdominal pain. History and physical examination are extremely important in making diagnosis. Associated symptoms should also be taken into account and how the pain is resolved. Speaking about surgical manifestations of abdominal pain Dr. Shahab Abid mentioned obstruction. High risk abdominal pain could be in patients with age over fifty years, those suffering from cardiac disease and early pregnancy. One should be vigilant. Collection of air in the lungs can also result in abdominal pain. He then shared four cases which he recently saw at AKU and discussed their management as well.

Prof. Husnain Ali Shah from AKU was the next speaker who talked about Heart Burn and GERD. This, he said, was a common symptom. Some may suffer from frequent and persistent heartburn. Almost 40% of people suffer form this once in their life time.  Almost 7% of these patients have symptoms of Gastro Esophageal Reflux Disease (GERD). It is a symptomatic nuisance but not life threatening condition. He also discussed the drugs which decrease LES pressure.

Speaking about the symptoms of GERD, Prof. Husnain Ali Shah mentioned heart burn, bleaching, regurgitation, hyper salivation. Therapeutic test by omeprazole, he opined, is very useful. If the sympto0ms are relieved with omeprazole and it works, one does not need any other sophisticated tests and it also saves money of the patient and healthcare facilities. Complications include esophagitis, hemorrhage, perforation and aspiration. As regards waning signs one has to be careful of dysphagia. Diagnosis is based on history and physical examination. Barium swallow was the first diagnostic test in this condition and not endoscopy.  Indications for endoscopy include failure to empiric therapy.  24 Hour PH monitoring is quite useful. Esophageal manometery is another common and useful investigation. The goal of therapy is alleviation of symptoms and to promote healing. In the treatment, he emphasized the importance of life style changes, modifications, use of antacids, proton pump inhibitors for eight to twelve weeks. At times the patients have to take these drugs for longer periods. Almost 50% of pregnant women, Prof. Husnain Ali Shah said complain of GERD.  He concluded is presentation by saying that in GERD medical treatment is effective and surgery is recommended in a very few selected cases. In Asia 5-7% of the population suffers from GERD symptoms. In case of alarming signs, endoscopy should be performed. PPIs are an effective treatment but it has t be life long in many cases.

Prof. Rauf Memon from DUHS also talked about functional dyspepsia and emerging therapy. He discussed in detail about drug induced dyspepsia, peptic ulcer disease, GI malignancy and many other conditions which are also responsible for dyspepsia.

Meeting at SIUT

According to a communication received from SIUT, a seminar on “Heartburn- a Global Perspective” was held there in collaboration with World Gastroenterology Organization (WGO) on the occasion of World Digestive Health Day 2015. During the presentations, it was pointed out that heartburn is a burning sensation in the chest, just behind the sternum. It occurs due to the reflux of acidic contents from stomach into the esophagus. It is a common medical disorder and affects about 25% of the population worldwide.  The speakers emphasized the need for creating awareness about the causes and complications of heartburn.

The speakers stressed upon avoiding smoking, acid enhancing beverages, citrus fruits and spicy foods. It was also advised to avoid large meals and not to lie down at least two hours after meals. Some patients who are unresponsive to these life style changes require medical therapy, however endoscopic or surgical options can also be employed in certain complications. It can also cause inflammation of the esophagus, esophageal ulcer/ narrowing and Barrett’s esophagus which can lead to cancer of esophagus. As regards heartburn in children, they usually present differently from adults with regurgitation recurrent vomiting, recurrent chest infection, wheezing and failure to grow. Apart from above mentioned complications in children extra-esophageal complications are slightly more common like bronchial asthma, recurrent aspiration pneumonia, recurrent ear and throat infection while treatment options are similar to adults. Those who addressed the seminar included Prof. Anwar Naqvi, Dr. Zaigham Abbas, Dr. Rajesh Mandhwani, Dr. Manzoor Siddiqui, Dr. Muhammad Ali Khalid, Dr. Amir Bakhsh, Dr Ghulamullah Lail and Dr. Ghous Bux Soomro.

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