Speakers discuss diagnosis and management of Gastro paresis, GERD, Functional GI Disorders and Constipation


 Gastroenterology Conference Proceedings-IV

Speakers discuss diagnosis and management
of Gastro paresis, GERD, Functional
GI Disorders and Constipation

KARACHI: Dr. Mehnaz Shafi from USA discussed management of Gastro paresis in one of the sessions on first day of the 33rd Annual Conference of Pakistan Society of Gastroenterology and GI Endoscopy held here from March 9-11, 2017. Speaking about symptoms she mentioned nausea, vomiting, bloating, abdominal pain, early satiety and post prandial fullness. Its incidence, she opined, was about one in hundred thousand population. It is not a common disorder but more common in women. She then discussed in detail the causes of delayed gastric emptying which included 33% idiopathic. Anorexia nervosa account for 5% and pseudo obstruction account for 3%. While evaluating these patients, one must screen them for diabetes, thyroid dysfunction, and neurological diseases. Take history of prior gastric or bariatric surgery, auto immune disease. She also referred to medication induced delay in gastric emptying and decreased gastric emptying in diabetics. Opiates, tricyclic agents, PPIs could be involved. The patient may complain of vomiting, GERD, weight loss, nausea and discomfort.

Speaking about the treatment Dr. Mehnaz Shafi said that first one must make the correct diagnosis. Identify the co morbid diseases, psychiatric diseases, and medication related issues. Take care of diet and life style modification which will help. She also discussed the effects of food on symptoms, the use of prokinetics in Gastro paresis. Various drugs are available which include Metoclopramide which is FDA approved. Its use should be limited to twelve weeks. Domperidone is effective in 60% of the patients. Itopride is available in Pakistan and many new drugs are likely to be made available in the market. She also discussed the role of neuro modulators in delayed gastric emptying as well as surgical gastro paresis. Psychiatric symptoms can hamper gastric emptying. Management, Dr. Mehnaz Shafi opined is multifactorial and it is important that one must optimize nutrition and assess severity of symptoms.

Dr. Varocha Mahachai from Bangkok Thailand spoke about Diffuse Esophageal Spasm. She emphasized the importance of detailed history, bedside assessment and structural defects. Investigations include barium swallow, CT, Time Barium, swallow, 24 hour Ph testing. Its pathophysiology is unknown. She then referred to monomeric criteria of diagnosis of DES and spastic esophageal disorder.  Clinical benefits, she said, are not conclusive.  PPIs, nitrates, antidepressants, endoscopic treatment are all effective in this common clinical problem. In 70% of esophageal disorders there is overlap of symptoms. Detailed history and various tests are useful. She also discussed in detail the pathogenesis of GERD, Refractory GERD and emphasized the importance of considering the compliance with therapy. Twenty four-hour Ph monitoring is required for diagnosis which is a gold standard for measuring acid exposure.

Dr. Greger Lindberg talked about how to evaluate pelvic floor dysfunction and management of constipation. He discussed at length the management of constipation and Ano Rectal Disorders. To begin with he talked about anatomy of anal canal and rectum. Medical history of patient with constipation, he opined, is very different. There are differences between perception of doctors and patient as regards feeling of incomplete emptying, soiling, incontinence, urgency. He also talked about Prolapse, trauma, surgery at birth.  Rectal examination of patient with constipation is important. The objective is measurement of functions. Use of catheter for high resolution anorectal manomatry was also discussed. He also referred to transit time measurement using radio opaque markers. On imaging, ultrasonography sphincter defects can be seen. He also showed some MR Photography slides and opined that none of the imaging tests was perfect. There are different types of constipation. In intractable constipation there could be insufficient response to standard treatment. He then discussed a few case histories and emphasized the importance of patient education, asking them to enhance push effort and train them to relax the pelvic floor muscles.

Dr. Faisal Wasim spoke on food hypersensitivity and FGID and pointed out that 25% of IBS patients have food hypersensitivity to shrimps, white egg, peanuts, beans etc. Almost 4% of patients with functional GI disorders have food hypersensitivity, he added. Dr. Minaz in her presentation said that constipation was a global problem. Many patients are not satisfied who get treatment. Dis-satisfaction leads to mistrust of physicians. In 396 patients they studied, 186 had functional constipation. About 30% were using fiber. She was of the view that proper understanding of patient’s complaints of constipation is essential. Events and nature of complaints should dictate medication and quality of life should be taken into consideration while managing these patients.